New calculator: Status Epilepticus Drug Dose

Convulsive status epilepticus is treated on a clock, and the arithmetic is trivial next to doing it in the right order under pressure. The Status Epilepticus Drug Dose Calculator turns one adult weight into every weight-based dose in the American Epilepsy Society 2016 algorithm, laid out phase by phase:

• Every drug, one weight — IM midazolam, IV lorazepam and IV diazepam in the initial phase with phenobarbital as the stated alternative, then levetiracetam, fosphenytoin and valproate as second therapy. Each card carries its single-dose cap and shows the arithmetic that the cap replaced.
• The label’s rate ceiling, next to the dose — each infusion shows the minimum time its own FDA label allows. A 2,985 mg phenobarbital load needs at least 50 minutes at the labelled 60 mg/min; fosphenytoin’s 1,500 mg PE cap divided by its 150 mg PE/min boxed-warning ceiling is exactly the 10 minutes ESETT used.
• Where the guideline leaves the label — levetiracetam at 60 mg/kg, valproate over 10 minutes and IM midazolam for seizures are all standard practice and none is a labelled use. The page says so on each card rather than leaving it for the pharmacist to discover.
• Contraindications first — porphyria for phenobarbital, urea cycle disorders and POLG for valproate, AV block for fosphenytoin, and the boxed warnings on midazolam and fosphenytoin, taken from the labels rather than summarised into caution.
• It refuses what it cannot do — below 40 kg no adult dose is shown and the per-kg rules disappear with it, because paediatric status epilepticus uses different bands. Anaesthetic doses in the refractory phase are titrated to EEG, so no number is printed for them.

New calculator: Vancomycin AUC Dosing

The 2020 ASHP/IDSA/PIDS/SIDP consensus guideline retired the 15–20 mg/L trough and put an AUC₂₄/MIC target of 400 to 600 in its place for serious MRSA infection. The Vancomycin AUC Dosing Calculator runs the guideline’s equation route — two timed steady-state levels through first-order pharmacokinetics — and shows every step it takes to get there:

• Offsets, not clock times — the peak is entered as hours after the infusion ends and the trough as hours before the next dose, and the page extrapolates each to the true end-of-infusion and end-of-interval concentration before integrating the interval. Draws outside the guideline’s 1-to-2-hour post-distributional window are flagged rather than silently used.
• It stops where the method stops — intervals longer than 24 hours are refused outright, because averaging a 48-hour cycle down to a day reports an exposure that belongs to neither day. When a draw time or a level looks implausible, the suggested daily dose is withheld instead of printed alongside the warning.
• Bayesian software is the guideline’s preferred route, and the page says so — this is the stated alternative: simpler and fully transparent, but a snapshot that assumes steady state and stable kidney function. Both limits are on screen, not buried in a footnote.

New calculator: Esmolol Infusion Rate

Esmolol is one of the few infusions whose concentration unit is not its dosing unit — the bag reads mg/mL while the order reads mcg/kg/min. The Esmolol Infusion Rate Calculator turns the order into a mL/hr pump rate, alongside the mg/hr and 24-hour totals that charts record:

• The ladder is the label’s own — 50, 100, 150 and 200 mcg/kg/min at intervals of at least 4 minutes, plus the 25 row the label notes has been adequate. The top rung is marked as the rate-control ceiling, with the label’s finding that about 95% of the patients who responded did so at 200 mcg/kg/min or less.
• The presets are the three containers actually supplied — the 2500 mg / 250 mL and 2000 mg / 100 mL premixed bags and the 100 mg / 10 mL vial. Choosing the vial says what the label supplies it for: a hand-held loading dose while the infusion is being prepared, not the infusion itself.
• Both loading doses, kept apart — 500 mcg/kg over 1 minute for gradual control and 1 mg/kg over 30 seconds for immediate perioperative control, each shown with its own millilitres. Only the first is the one the label calls optional.

New calculator: Vasopressor Equivalent Dose

Once a patient is on norepinephrine plus vasopressin plus angiotensin II, no single infusion rate describes how much support is being given. The Vasopressor Equivalent Dose Calculator rolls six concurrent vasopressors into one norepinephrine equivalent (NEE) in mcg/kg/min, and shows what each agent contributes:

• One stated formula, with its correction applied — the updated equation published in Critical Care in 2023, including the 2025 correction. Published formulas disagree with each other, so the page names the one it uses and shows where the others differ.
• The units are the risk, so the units are guarded — vasopressin is entered as a flat units/min rate and angiotensin II in ng/kg/min, because that is what their coefficients were published in. Entering an hourly rate in the per-minute box, or a flat order in the per-kilogram box, raises a check-the-units prompt naming the button to press.
• No severity bands, deliberately — the source paper defines no threshold for high-dose or refractory shock, so none is invented here. NEE describes exposure, not weanability, and the page says so on screen.

It is a severity and reporting measure, not a dosing tool: it must never be used to program a pump or to convert one running vasopressor into another.

New calculator: Phenylephrine Infusion Rate

Phenylephrine is ordered two different ways, and the two conventions do not convert cleanly. The Phenylephrine Infusion Rate Calculator accepts either and shows both, because the two current FDA labels for the same 10 mg/mL vial disagree:

• Weight-based mcg/kg/min — the ASHP Standardize 4 Safety adult standard, and the Fresenius label, which covers anesthesia and septic shock at 0.5–6 mcg/kg/min.
• Flat mcg/min — the Baxter label, indicated for hypotension during anesthesia only, at 10–35 mcg/min and never above 200.
• They are not interchangeable — at 80 kg the flat maximum of 200 mcg/min is only 2.5 mcg/kg/min, far below the weight-based shock ceiling of 6. Every row carries both units so the mismatch stays visible.

Colour bands follow each label’s own ranges, and the top rung is flagged where the label states that higher doses give no further rise in blood pressure. The bolus box is scoped to the anesthesia setting — in septic or other vasodilatory shock the vial label directs no bolus.

New calculator: Insulin Infusion Rate

An IV insulin infusion is the one drip where the arithmetic usually disappears: at the ASHP Standardize 4 Safety adult standard of 1 unit/mL, mL/hr and units/hr are the same number. The Insulin Infusion Rate Calculator exists for the moment that stops being true — a non-standard bag — and for the two clinical contexts that use different units:

• Both dosing units, because ASHP lists both — flat units/hr for nurse-driven ICU glucose control, and units/kg/hr for the fixed-rate DKA protocol. Each row shows the other unit, the mL/hr rate, and the 24-hour projection.
• The weight-based table shows only guideline-anchored rates — 0.05 and 0.1 units/kg/hr, both traceable to the 2024 ADA/EASD consensus on hyperglycemic crises. A doubling step that appears in many local protocols was removed during review because no published guideline states it.
• The potassium gate comes before the number — insulin is held until K+ is at least 3.5 mmol/L, and the custom-concentration mode is bounded by the labeled IV range of 0.1–1 unit/mL.

Every clinical figure on the page carries a recorded primary source, verified against the full text rather than a summary.

New calculator: Fentanyl Infusion Rate

Fentanyl is the opioid infusion most adult ICUs actually run — it accounted for 83.7% of opioid infusions in a 2026 analysis of 8,262 ventilated patients — yet it is prescribed in two different units, sometimes on different units of the same hospital. The Fentanyl Infusion Rate Calculator converts either form into a pump rate and shows both at once, so a flat order and a weight-based one can never be read for each other:

• Flat mcg/hr by default, mcg/kg/hr as a labelled second mode — the ASHP Standardize 4 Safety adult standard dosing unit for fentanyl is mcg/hour, and no guideline specifies which body weight a weight-based order should use. Both columns are always visible, along with the mL/hr rate and the 24-hour total.
• The reference table is observed practice, not a recommendation — its colour bands are keyed to the interquartile range actually received by 144 ventilated adults in a 2025 cohort (average 55 mcg/hr, IQR 39–75). The legacy 0.7–10 mcg/kg/hr figure quoted in many references comes from a 2013 background table that was never reaffirmed; its ceiling is about 700 mcg/hr in a 70 kg adult, and the tool will not produce it.
• Guards on the inputs that actually cause harm — ASHP standard concentrations of 10 and 50 mcg/mL as presets, a custom mode that refuses implausible concentrations and names the milligram-for-microgram trap, an adults-only floor, a low-flow and line-flush warning where the hourly volume falls below the dead space of an extension set, and a prompt to reassess rather than escalate above roughly 150 mcg/hr.
• What it deliberately will not do — it does not convert an infusion to a transdermal patch, because no validated conversion exists for critically ill patients, and it does not display a morphine milligram equivalent, because there is no CDC-sanctioned factor for an intravenous fentanyl infusion.

The page also carries the parts of the evidence that a rate alone cannot express: iatrogenic withdrawal after 72 hours, why duration matters more than rate, why an opioid infusion should not be raised to treat agitation, and the fact that fentanyl-induced rigid chest syndrome is described on continuous infusion and not only after a bolus. Every citation was verified to its source record.

New calculator: Levosimendan Infusion Rate

Added by user request, the Levosimendan Infusion Rate Calculator joins the vasopressor and inotrope tools. Levosimendan is the one calcium-sensitising inodilator in the set — it raises contractility without increasing myocardial oxygen demand and works even under β-blockade — and, being unapproved in the US, it is missing from most North American dosing references. The calculator converts a weight-based dose into a pump rate for both standard dilutions of the 2.5 mg/mL concentrate:

• Optional loading dose, off by default — the three largest perioperative trials (LEVO-CTS, CHEETAH, LICORN) all omitted the bolus to avoid excessive vasodilation, so the tool starts with no loading dose and offers 6 or 12 mcg/kg only when you choose it.
• Full titration table with 24-hour volumes — 0.05 to 0.2 mcg/kg/min, each row showing the mL/hr rate, the total 24-hour volume, and the number of 500 mL bags a complete course needs.
• The safety points that matter — the licensed indication (acutely decompensated heart failure) versus off-label surgical and shock use, the CrCl < 30 and Torsades contraindications, correcting potassium first, and the long tail of the active metabolite that keeps working for days after the infusion stops.

Every figure is cross-checked against the manufacturer’s published infusion tables, and every citation is verified to PubMed. It is a dosing aid for qualified clinicians, not a substitute for the approved product information in your country.

Tool spotlight: the Empiric Antibiotic Selector

One of our newer Infection tools deserves a closer look. The Empiric Antibiotic Selector builds a risk-stratified starting regimen — the antibiotics to give before cultures return — from the infection site, where it was acquired, known resistant colonization, host factors, severity, and β-lactam allergy. It distills current IDSA, ATS, SIS, and Surviving Sepsis Campaign 2026 guidance into one bedside workflow:

• Eight infection sites — pneumonia, complicated UTI, intra-abdominal, skin/soft tissue, catheter-related bloodstream, CAUTI, febrile neutropenia, and undifferentiated sepsis — each mapped to its likely pathogens and first-line regimen.
• Stewardship built in — following the Surviving Sepsis Campaign 2026, MRSA, double Gram-negative, and antifungal coverage are added only when risk factors are present, not reflexively, even in septic shock.
• An alternative agent on every card — for intolerance, toxicity, or drug shortage — plus resistance-aware guidance (a carbapenem over piperacillin-tazobactam for ESBL per MERINO; aztreonam-avibactam for metallo-β-lactamase CRE).
• Penicillin allergy, reframed — true cephalosporin cross-reactivity is about 1–2%, so side-chain–different cephalosporins and carbapenems stay on the table for most patients.

As always, it’s an empiric starting point — draw cultures first, substitute your local antibiogram, and de-escalate at 48–72 hours. Not for meningitis, pediatrics, pregnancy, or endocarditis.

Critical Care Reviews: the full series is now live

Following ARDS, six more evidence-based reviews have joined the Critical Care Reviews section — it now covers the core of ICU practice end to end. Each is organized by treatment area, with the landmark trials and society guidelines behind every recommendation, and every citation verified to PubMed:

• Targeted Temperature Management (TTM) — post–cardiac-arrest temperature control (32–37.5 °C) and fever prevention, with neuroprognostication — TTM2, HYPERION, and 2025 AHA / ERC–ESICM guidance.
• Sepsis & septic shock — early resuscitation, vasopressors, and antibiotics under the Surviving Sepsis Campaign 2026 — CLOVERS, the 65 trial, and BLING-III.
• Mechanical ventilation — lung-protective settings, PEEP, and weaning — ARMA/ARDSNet, ART, PReVENT, and Subirà.
• AKI & CRRT — renal replacement timing, modality, and dose — STARRT-AKI, AKIKI-2, BigpAK-2, and 2025 SRLF–GFRUP.
• Transfusion — restrictive thresholds and massive-hemorrhage resuscitation — AABB 2023, PROPPR, MINT, and CRASH-2.
• Nutrition — calorie and protein targets and feeding route — NUTRIREA-3, EFFORT, EPaNIC, and NICE-SUGAR.

New section: Critical Care Reviews (starting with ARDS)

A new Critical Care Reviews section turns the key evidence into bedside management — organized by treatment area, with the landmark trials behind each recommendation. First topic now live:

• ARDS — Evidence-Based Management & Landmark Trials: lung-protective ventilation, PEEP, prone positioning, neuromuscular blockade, corticosteroids, fluids, oxygenation targets, and ECMO — each with the current standard of care and the trials behind it (ARMA, PROSEVA, DEXA-ARDS, EOLIA, and more), with every citation verified to PubMed.
• Reflects current society guidance (ATS/ESICM/SCCM 2017, ESICM 2023, and the 2024 SCCM corticosteroid update).

New: Nutrition Support Guide for Hospitalized Patients

A comprehensive Nutrition Support Guide is now live, turning ASPEN (2022) and ESPEN (2023) guidance into a single bedside workflow:

• Automatic BMI, ideal and adjusted body weight, with calorie and protein targets individualized by clinical condition (critical illness, CKD/CRRT, burns, trauma, obesity, and more).
• Nutrition route selection (EN vs PN), enteral and parenteral product matching, and a refeeding-syndrome risk assessment.
• Reflects recent trials — NUTRIREA-3, EFFORT, and PRECISe — including the move away from routine high-dose protein.

Two new infectious-disease tools

Two evidence-based Infection tools are now live, built from current IDSA, SIS, and Surviving Sepsis guidance:

• Empiric Antibiotic Selector — risk-stratified empiric regimens by infection site, acquisition, MDR colonization, host factors, severity, and β-lactam allergy, with an alternative agent now listed on every regimen card (for intolerance, toxicity, or drug shortage).
• Bacterial Meningitis: Diagnosis & Empiric Therapy — a CT-before-LP checklist, CSF interpretation, CNS-dose empiric antibiotics, and dexamethasone timing.

Three new acid–base & toxicology calculators

We added three new bedside tools, each cross-linked with the ABG Analyzer:

• Anion Gap Calculator — with albumin correction and the delta ratio for mixed metabolic disorders.
• Winters’ Formula Calculator — expected PaCO₂ and respiratory compensation in a primary metabolic disorder.
• Serum Osmolality & Osmolar Gap Calculator — screens for unmeasured osmoles (toxic alcohols), with an optional ethanol term.

Library-wide medical review

Every DosePilot calculator and clinical guideline was reviewed against current evidence and now shows a “Last medically reviewed” date. Refreshed guidance includes:

• Acute Coronary Syndrome — 2025 ACC/AHA
• Atrial fibrillation rate control — 2023 ACC/AHA & 2024 ESC
• DKA / HHS — 2024 ADA/EASD consensus
• Sepsis vasopressors — Surviving Sepsis Campaign 2026

Key calculators updated to current standards

Selected tools were aligned with the latest formulas and references — including MELD 3.0 for liver-disease severity and the race-free 2021 CKD-EPI equation for eGFR.

Faster, cleaner data entry

We redesigned the on-screen number keypads across the calculators so each digit row fits cleanly on a single line — quicker, clearer entry on phones and tablets.