AZense Guideline Updates

Beta-hydroxybutyrate at the bedside, subcutaneous insulin for mild DKA, and HHS resolution criteria for the first time ever

KDIGO 2012 is still the official standard — a major update is in public review. How to practice confidently in the gap.

From classification overhaul to dupilumab eligibility — what hospitalists need when the patient cannot breathe

ATS 2025 update changes steroids and antibiotic duration — how to use both the 2019 and 2025 guidance together

The Surviving Sepsis Campaign returns — 46 new statements, and the 1-hour clock just got more nuanced

2023 ACC/AHA/ACCP/HRS Guideline for Diagnosis and Management of Atrial Fibrillation, with 2024 ESC AF-CARE context

2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure, with 2023 ESC focused update context

Part two of a two-part stewardship curriculum: syndrome-by-syndrome empiric choices, de-escalation, and usual durations - from CAP and sepsis to endocarditis, bacteremia, and the resistant-organism curveballs, with what actually changed in 2024-2026 (the 2025 CAP steroid reversal, the first-ever IDSA complicated-UTI four-step framework, the seven-day gram-negative bacteremia rule, and the days-old...

Part one of a two-part curriculum. How to reason from Gram stain to a narrow, correct regimen: the gram-negative and gram-positive coverage maps, organism-specific first-line logic, the MSSA-off-vancomycin reflex, the resistant-organism villains in plain language, and the four stewardship habits - de-escalation, culture interpretation, IV-to-oral, and source control - with when to call ID

The complications deep dive: hepatic encephalopathy and the ammonia trap, reading the ascitic tap and the SBP prophylaxis controversy, variceal bleeding drug and PPI decisions, HRS-AKI with terlipressin guardrails, why chest tubes harm in hepatic hydrothorax, and using ACLF grade rather than MELD alone to drive the transfer and transplant conversation

The 2025 BSG/BASL/SAM admission bundle tightens the first 6 hours, adds Doppler ultrasound, and drops routine coagulopathy correction, while AASLD, AGA, EASL, and ACG guidance reshape SBP, HRS-AKI, variceal bleeding, portal vein thrombosis, and alcohol-associated hepatitis

The 2022 ACC/AHA aortic disease guideline unifies thoracic and abdominal aortic care, lowers surgical thresholds at expert centers, expands genetic testing and family screening, and standardizes acute aortic syndrome management

The 2023 AHA/ACC chronic coronary disease guideline renames stable ischemic heart disease, elevates SGLT2 inhibitors and GLP-1 therapies, de-escalates routine long-term beta-blockers, and ties revascularization to symptoms rather than ischemia alone

The first unified AHA/ACC/ADA/ASN guideline defines cardiovascular-kidney-metabolic syndrome, introduces a 0 to 4 staging system, mandates PREVENT-based risk estimation, and places SGLT2 inhibitors and GLP-1 therapies at the center of cardiometabolic care

The Surgical Infection Society 2024 update is the antimicrobial and antifungal therapy companion to IDSA 2024 Part 1, which covered diagnosis only; it advises against empiric antifungals in lower-risk community-acquired infection and recommends anidulafungin for higher-risk Candida intra-abdominal infection, all anchored on adequate source control

The IDSA 2024 update on complicated intra-abdominal infections, Part 1, covers risk assessment, diagnostic imaging, and microbiological evaluation only; antimicrobial therapy, source control, and antifungal guidance are reserved for later parts

The CHEST 2025 companion guideline issues seven conditional recommendations that withhold prophylactic plasma and platelet transfusion in most ICU settings, with lumbar puncture as the one procedure that flips the default

The CHEST 2024 red cell transfusion guideline makes a restrictive hemoglobin 7 to 8 strategy the strong default across critical illness and GI bleeding, but recommends against a restrictive strategy in acute coronary syndrome

The 2024 KDIGO CKD guideline gives a tiered SGLT2 inhibitor recommendation, strong for type 2 diabetes with CKD, strong for heavy albuminuria or heart failure regardless of diabetes, and a weaker suggestion for low-albuminuria low-eGFR disease, not a blanket recommendation for all CKD

The living IDSA guidance retires piperacillin-tazobactam for serious ESBL disease, makes ceftazidime-avibactam standard for KPC-type CRE, prefers sulbactam-durlobactam for CRAB, and requires novel agents for DTR-Pseudomonas

Basal-bolus insulin is the standard for eating non-ICU patients, targets are 140 to 180 mg/dL for most, admission A1C drives the plan, and sliding scale alone is not adequate

The 2025 IDSA update defines complicated UTI by clinical findings rather than risk factors alone, retires fluoroquinolones as empiric therapy, and favors carbapenems over piperacillin-tazobactam for ESBL disease

The 2026 update makes tenecteplase co-equal with alteplase, replaces thrombolysis with dual antiplatelet therapy for non-disabling stroke, and expands thrombectomy to large-core infarcts

GINA 2026 adds four acute asthma flowcharts, an ICS-SABA reliever option at Step 1, conservative oxygen and SABA dosing, single-exacerbation treatment review, and the first twice-yearly biologic

The WHO issues its first guideline endorsing GLP-1 medicines for adult obesity, while AACE reframes obesity as adiposity-based chronic disease with complication-centric, cost-aware pharmacotherapy