🔴 أكثر خطرًا على مريض التليف الكبدي : omeprazole#
🟢 أقل خطرًا على مريض التليف الكبدي : esomeprazole#
صلاح الدين منصور الضبارة

🛑Proton pump inhibitors and liver cirrhosis
✅ For patients with cirrhosis and an indication for PPIs, we typically use esomeprazole, when available, based on pharmacokinetic data

✅ For patients with decompensated cirrhosis, omeprazole, lansoprazole, and rabeprazole are generally avoided 

#Uptodate

🛑Anemia in pregnancy
✅can be defined as follows, based mostly on data in nonpregnant individuals

✅First trimester – Hemoglobin <11 g/dL (approximately equivalent to a hematocrit <33 percent)

✅Second trimester – Hemoglobin <10.5 g/dL (approximate hematocrit <32 percent)

✅Third trimester – Hemoglobin <11 g/dL (approximate hematocrit <33 percent)

✅Postpartum – Hemoglobin <10 g/dL (approximate hematocrit <30 percent
#Uptodate

🛑Iron requirements during pregnancy

✅In the first trimester, approximately 1 to 2 mg/day

✅ in  second trimester, the demand for iron increases to 4 to 5 mg/day

✅In the third trimester, the demand for iron increases to approximately 6 mg/day

#UPTODATE2026

🛑Iron requirements during pregnancy
✅In the first trimester, approximately 1 to 2 mg/day of iron is needed due to normal gastrointestinal sloughing and the early pregnancy-related increase in RBC mass

✅By the second trimester, the demand for iron increases to 4 to 5 mg/day due to requirements for increased maternal RBC production as well as fetal RBC production and fetoplacental growth


✅In the third trimester, the demand for iron increases to approximately 6 mg/day due to ongoing maternal and fetal RBC production and fetoplacental growth.

🛑The prevalence of anemia in pregnancy based on WHO definitions was

✅-First trimester – 3 percent

✅-Second trimester – 2 percent

-✅Third trimester – 11 percent

🔴 أكثر خطرًا على مريض التليف الكبدي : مسكنات NSAIDs ( مثل ibuprofen )
🟢 أقل خطرًا على مريض التليف الكبدي : paracetamol( بجرعه يومية 2جرام)
صلاح الدين منصور الضبارة

🛑short acting CCB VS long acting CCB drugs

🛑ACEI /ARB drug and hyperkalemia
✅ACE inhibitors and ARBs generally raise the serum potassium concentration by less than 0.5 mEq/L in patients with relatively normal kidney function.

✅More prominent hyperkalemia may be seen in patients with chronic kidney disease, diabetes, concurrent use of a drug promoting potassium retention such as a potassium-sparing diuretic or a nonsteroidal antiinflammatory drug, or among older adult

#UPTODATE2026
#Clinical_Notes

🛑fever in surgical patients
✅Most patients with fever after the third postoperative day have an infection.
#UPTODATE2026
#Clinical_Notes

✅Antibiotics are not routinely indicated for most patients with fever in the early postoperative periods( within the first three days after surgery)
✅ but hemodynamically unstable patients should be treated empirically with broad-spectrum antibiotics, which should be discontinued after 48 hours if no source of infection has been identified.
#Clinical_Notes

🛑Hypocalcemia and nephrotic syndrome
✅Hypocalcemia is common, however, due to hypoalbuminemia; this does not affect the physiologically important free (or ionized) calcium concentration.
✅Measurement of the ionized calcium concentration is generally required to confirm hypocalcemia in nephrotic patients with a low total serum calcium.

#UPTODATE2026

🛑 beta blockers and esophageal varices. 

🅰We do not initiate beta blockers to prevent recurrent bleeding in patients with any of the following conditions because of the risk of adverse events (eg, decreased cardiac output, increased mortality):

✅Hyponatremia (serum sodium concentration <130 mEq/L)

✅Acute kidney injury

✅Spontaneous bacterial peritonitis: Beta blocker therapy in patients with spontaneous bacterial peritonitis is associated with higher mortality risk

✅Diuretic-resistant ascites: Beta blocker therapy in patients with diuretic-resistant ascites is associated with higher mortality risk

●History of adverse effects with beta blockers: Patients with a prior history of adverse effects related to beta blockers are not candidates for therapy (eg, bronchoconstriction, heart failure, acute kidney injury)

✅Systolic blood pressure <90 mmHg

#UPTODATE2026

✅كل معلومة انشرها هنا هي صدقه جارية لروح والدي بإذن الله
اللهُم أجعل قبر أبي مُنيراً بارداً ، وأفتح له باباً تهبّ منه
نسائم الجنة لا يُسد أبداً ..❤

دواء Colchicine قد تجده في وصفة مريض
✅Gout
✅Pseudogout
✅familial Mediterranean fever
✅Pericarditis
✅Behcet's disease
✅Acut cornory syndrome
#Salah