The Daily Med

THE DAILY EDITIONFRIDAY, 6 NOVEMBER 2026

Case of the Day · Clinical Reasoning

ECG changes make hyperkalemia an emergency.

A 64-year-old with CKD taking an ACE inhibitor presents weak. Potassium is 7.1 mmol/L and ECG shows QRS widening with peaked T waves.

What is the first immediate intervention?

Drug Corner

Pharmacology in practice

XANTHINE OXIDASE INHIBITOR

Allopurinol (oral)

Indication: Long-term urate lowering in gout and selected hyperuricaemic conditions.
Mechanism: Inhibits xanthine oxidase and reduces uric-acid formation.
Interactions: Azathioprine/mercaptopurine exposure rises markedly: avoid or reduce thiopurine to 25% with close blood-count monitoring if combination is essential.
Important adverse effect: Rash can precede severe hypersensitivity; stop and urgently assess.
Dosing: Start low (often 100 mg/day), then titrate to serum urate target; account for renal function.
Sources: SmPC: https://www.medicines.org.uk/emc/product/14132/smpc

Paper of the Day

Research, without the noise

Emergency medicine · Syncope

Immediate Ambulatory Electrocardiographic Monitoring in Syncope

In an open-label UK RCT at 45 hospitals, 2,234 adults with unexplained syncope after ED evaluation were assigned to 14-day ambulatory ECG or standard care. At one year, mean reported syncope episodes were 1.37 vs 1.58 (IRR 0.89, 95% CI 0.68–1.18; P=0.42); the primary outcome did not differ significantly.

Authors: M.J. Reed and Others

Published: 30 August 2026 · New England Journal of Medicine

DOI: 10.1056/NEJMoa2605812

Read the original paper →

Journal Watch

What's new in medicine?

Pulmonology · COPD

Comparative effectiveness of azithromycin versus roflumilast in patients with chronic obstructive pulmonary disease: emulated target trial

In a matched claims cohort, azithromycin initiation was associated with lower hazard of first moderate/severe exacerbation (HR 0.83, 95% CI 0.79–0.87); residual confounding and unmeasured safety outcomes limit causal conclusions.

Nephrology · Diabetic kidney disease

Renal outcomes in people with type 2 diabetes with and without albuminuria treated with SGLT-2 inhibitors and GLP-1 receptor agonists: target trial emulation

This target-trial emulation compared renal outcomes by albuminuria; observational findings should be interpreted alongside randomized evidence and individual indications.

Cardiology · Heart failure

Effect of Sotagliflozin on Kidney Function and Cardio-Kidney-Metabolic Parameters Across Baseline eGFR Subgroups in Patients With Type 2 Diabetes and Stage 4 CKD

The PubMed record identifies an eGFR-subgroup analysis in stage 4 CKD but has no abstract; findings could not be verified, so no efficacy claim is made.

Today's Topic

Build your clinical knowledge

Cardiology · Conduction disease

Conduction defects: identify unstable block and reversible causes

Diagnosis / Testing

Obtain a 12-lead ECG, compare prior tracings and assess symptoms, haemodynamics, medications and electrolytes. Characterize AV block type and level; evaluate ischemia and other reversible causes.

Treatment / Care Decisions

Treat instability with monitoring, appropriate chronotropic support or temporary pacing while correcting reversible causes. Permanent pacing depends on the persistent conduction disorder and guideline indications.

Risk Assessment / Prognosis / Epidemiology

Syncope, hypotension, ischemia, heart failure or high-grade block are high-risk features. Consider progression and underlying structural disease.

Pathophysiology / Basic Science

Fibrosis, ischemia, infiltrative or congenital disease and medicines can impair impulse formation or conduction; block site and substrate inform progression and pacing decisions.

Further reading: 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy.