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1-3 of 3 results by Hanna Hussein
Educational Pearls for the ED:
Many Muslim patients with diabetes will fast despite medical advice. Studies show a significant number continue fasting even when they are considered high risk.
Key medical risks during Ramadan fasting include:
- Hypoglycemia
- Hyperglycemia and diabetic ketoacidosis
- Dehydration
- Medication nonadherence or altered dosing schedules
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As emergency clinicians, we frequently encounter patients from diverse cultural and religious backgrounds, including a growing Muslim population. This guide outlines key pharmacological considerations when caring for Muslim patients, focusing on the presence of alcohol and porcine-derived gelatin in commonly prescribed medications, two ingredients that may conflict with Islamic beliefs. Drawing from real cases and institutional data at Jefferson Health, the authors highlight how such conflicts can lead to medication refusal, delays in care, and decreased adherence.
The article presents a practical and EM-friendly framework for identifying potentially problematic ingredients using tools like the FDA’s National Drug Code (NDC) and the DailyMed database. It also offers substitution strategies and highlights that alternatives often exist, such as switching from suspensions to tablets or selecting alcohol-free formulations. Importantly, the authors explore the Islamic principles of necessity (darura) and transformation (istihalah), which allow for flexibility in life-saving situations. By integrating cultural awareness into our prescribing habits and leveraging simple EHR strategies, such as tagging “pork” as an allergy to trigger alerts, we can provide more inclusive, respectful, and effective care in the ED without adding significant burden to clinical workflows.
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Ramadan is the holy month in the Islam faith, where observers will fast from sunrise to sunset. This includes food, water, some medications, smoking and sex. This can obviously have some impact on patients' health, especially when presenting to the ED. Here are some considerations to keep in mind:
- In general, there are exemptions to fasting for pregnant persons, children, breastfeeding persons, and people travelling.
- Bleeding is considered a contraindication to fasting, so menstruating women are exempt. Some people may interpret this to mean they cannot give blood or have lab work done, but there is an exemption for medical purposes
- Volume status is probably the main area to be concerned about. Always ask your patients if they are currently fasting and explain why IV fluids would be necessary
As with everything, maintaining cultural awareness and compassion will help to