Rx Note

Introduction Enuresis is urinary incontinence while sleeping (at night or during naps). By definition, it is not considered abnormal until 5 years of age and must occur at least twice weekly for ≥3 consecutive months. In other words, nocturnal enuresis, or bed-wetting, is a normal part of a child's development and is not generally treated before age 5 years. Management Offer reassurance that most enuresis resolves over time. 15% per year among children >6 years old. Behavioural treatments are used first. Fluid restriction in hours prior to bedtime. Elimination of products that cause diuresis or bladder irritation such as caffeinated beverages. Maintain normal fluid intake during the day. Advise scheduled urinations during the daytime (4-7 times per day) and voiding just prior to bedtime. Enuresis alarm in motivated and compliant family. For patients beginning at age 6 years, offer desmopressin (0.2-0.4 mg tablet or 0.12-0.24 mg sublingual tablet) orally 1 hour prior to bedtim...

Introduction Heart failure is not a single pathological diagnosis, but a clinical syndrome consisting of cardinal symptoms (e.g. breathlessness, ankle swelling and fatigue ) that may be accompanied by signs (e.g. elevated jugular venous pressure, pulmonary crackles, and peripheral oedema ). It is due to a structural and/or functional abnormality of the heart that results in elevated intracardiac pressures and/or inadequate cardiac output at rest and/or during exercise . The median survival following a diagnosis is around 3 to 5 years. A commonly used classification is by left ventricular ejection fraction (LVEF). HFrEF - Heart failure with reduced ventricular ejection fraction (i.e.≤ 40%) HFmrEF - Heart failure with mildly reduced ventricular ejection fraction (i.e. 41-49%) HFpEF - Heart failure with preserved ventricular ejection fraction (i.e. ≥50%) New York Heart Association (NYHA) Functional Classification The simplest terminology used to describe the severity of HF is the NYHA fun...

Introduction Dengue is a febrile illness caused by infection with 1 of 4 dengue viruses (DENV) transmitted by Aedes aegypti or Aedes albopictus mosquito. In Malaysia, all 4 serotypes can be isolated at any given time. Each episode of infection induces a life-long protective immunity to the homologous serotype but confers only partial and transient protection against other serotypes. Secondary infection with a different serotype is a major risk factor for severe dengue due to antibody-dependent enhancement. Symptoms The incubation period of DENV infection ranges from 3 to 14 days; symptoms typically develop between 4 and 7 days after the bite of an infected mosquito. Phases of infection Febrile phase Patients typically develop a sudden high-grade fever. This acute febrile phase usually lasts 2-7 days and is often accompanied by headache, vomiting, myalgia, arthralgia, eye pain and a transient macular rash in some cases. Critical phase Only seen in severe dengue or dengue with war...

Introduction Fluid balance is Estimating the input and output of fluid in the body. Accounting for redistribution of fluid and electrolytes outside the plasma volume. In principle, all fluid into and out of the body should be measured and recorded on a fluid balance chart. In actual clinical practice, it is more common to express an opinion about fluid status. Assessment of fluid status Signs of pulmonary or peripheral oedema Dry mucosa, sunken eye appearance or patient feeling thirsty Poor urine output (<0.5 ml/kg/hour) Slow capillary refill (more/less than 2 seconds) Blood pressure - central venous or jugular or postural hypotension Pulse and heart rate Altered conscious state Loss of weight over days (not weeks) Concentration of biochemistry May also consider fluid challenge by passive leg raise or fluid bolus protocol. Intravenous Fluids Intravenous fluids are used to replace fluid losses and treat various conditions . They are categorized as crystalloids or colloids. Crystalloi...