Medical intelligence to elevate clinical practice

Dengue deteriorates as the fever settles

The critical phase of plasma leakage begins at defervescence, usually days 4-6. A rising haematocrit with a falling platelet count and a narrow pulse pressure means compensated shock, even when the systolic reading looks normal.

Source: WHO dengue guidance 2024 · demo summary

Withhold SGLT2 inhibitors during acute illness and before surgery

Empagliflozin and other SGLT2 inhibitors cause ketoacidosis at normal or near-normal glucose. Hold during vomiting, fasting, low-carbohydrate intake and typically for 3 days before surgery, and diagnose on ketones and pH rather than glucose.

Source: DrZep drug monograph · demo dataset

Complete the four pillars in HFrEF before adding anything else

ACE inhibitor or ARB (ideally sacubitril-valsartan), beta-blocker, mineralocorticoid receptor antagonist and SGLT2 inhibitor together deliver the largest mortality reduction. Loop diuretics relieve congestion but do not extend life.

Source: ESC heart failure guideline 2023 · demo summary