⚠️ BREAK FAST IF:
• Urine output <2 times in 12 hours
• Swelling in feet/ankles
• Severe fatigue or confusion
• Nausea/vomiting
• Muscle cramps (severe)
• Dizziness when standing
🚨 EMERGENCY - BREAK FAST AND GO TO HOSPITAL:
• Yellowing of eyes/skin (jaundice)
• Dark urine (tea-colored)
• Abdominal swelling/pain
• Vomiting blood or coffee-ground material
• Black/tarry stools
• Confusion, drowsiness, slurred speech
• Bleeding gums or easy bruising
🤒 PART 4: TYPHOID FEVER
ABSOLUTE CONTRAINDICATION TO FASTING
╔═══════════════════════════════════════════════════════╗
║ URGENT WARNING ║
╠═══════════════════════════════════════════════════════╣
║ PATIENTS WITH ACUTE TYPHOID FEVER SHOULD NOT FAST ║
║ ║
║ • High fever causes dehydration ║
║ • Increased risk of intestinal perforation ║
║ • Antibiotics require regular dosing ║
║ • Nutritional support critical ║
╚═══════════════════════════════════════════════════════╝
If Recovering from Typhoid (Post-Fever)
Precautions for Convalescent Patients
Aspect
Recommendation
Timing
Only fast if afebrile for >7 days AND cleared by doctor
Hydration
EXTRA fluids between Iftar and Suhoor
Diet
Light, easily digestible foods
Medications
Complete full antibiotic course – adjust timing with meals
🧂 SALT RESTRICTION IS CRITICAL
HIGH SALT FOODS TO AVOID:
• Pickles, olives
• Canned soups
• Processed meats (sausages, bacon)
• Salty snacks (chips, salted nuts)
• Restaurant fried foods
• Cheese (especially feta, halloumi)
LOWER SALT ALTERNATIVES:
• Fresh foods
• Herbs and spices for flavor
• Lemon juice
• Garlic, onion powder
• Homemade meals
BP Monitoring Schedule
📊 CHECK BLOOD PRESSURE:
1. Before Suhoor
2. Midday (if possible)
3. Before Iftar
4. 2 hours after Iftar
KEEP A LOG 📝
Hypotension (Low Blood Pressure)
Precautions
Aspect
Recommendation
Hydration
EXTRA fluids – 10+ glasses between Iftar and Suhoor
Salt intake
Slightly increased (unless contraindicated)
Caffeine
Can help – tea/coffee with meals
Medications
May need dose reduction – consult doctor
Warning Signs – BREAK FAST
⚠️ BREAK FAST IF:
• Dizziness on standing
• Fainting or near-fainting
• Blurred vision
• Severe fatigue
• Palpitations
🦋 PART 7: THYROID DISORDERS
Hypothyroidism (Underactive Thyroid)
Aspect
Recommendation
Levothyroxine timing
Take on empty stomach, 30-60 min before food
Ramadan adjustment
Take at Suhoor (pre-dawn) with water only, wait 30-60 min before eating
Food interactions
Avoid calcium, iron, fiber supplements within 4 hours
Monitoring
Check TSH after Ramadan
Sample Suhoor Schedule for Thyroid Patients
SUHOOR TIMELINE:
🌙 4:00 AM - Wake up
💊 4:05 AM - Take levothyroxine with WATER ONLY
⏳ 4:05-4:45 AM - Wait (pray, recite Quran)
🍽️ 4:45 AM - Eat Suhoor meal
🌅 5:15 AM - Stop eating (fast begins)
🚫 NO dairy, calcium, iron in Suhoor meal
Hyperthyroidism (Overactive Thyroid)
Aspect
Recommendation
Carbimazole/PTU
Take with Iftar and Suhoor as prescribed
Beta-blockers
For symptoms – take with meals
Calorie needs
Higher – ensure adequate nutrition at night
Hydration
EXTRA important – hyperthyroidism increases fluid loss
💨 INHALER RULING (Islamic Perspective)
Most scholars permit use of inhalers during fasting because:
• It is aerosolized medication reaching lungs
• Not nutrition
• Emergency need
HOWEVER:
• Use only when necessary
• If using >2-3 times daily, consider breaking fast
• Severe asthma attack = BREAK FAST immediately
Precautions
Aspect
Recommendation
Preventer inhaler
Use at Iftar and Suhoor as prescribed
Reliever inhaler
Carry at all times – use if needed
Triggers
Avoid dust, smoke, strong odors
Hydration
Adequate fluids to prevent thick mucus
Humidifier
Helpful at night
Warning Signs – BREAK FAST
🚨 ASTHMA EMERGENCY - BREAK FAST AND SEEK HELP:
• Unable to complete sentences due to breathlessness
• Reliever inhaler not helping
• Wheezing loud or silent chest
• Lips or fingers turning blue
• Severe anxiety/distress
• Fever with breathlessness
📋 PART 9: OTHER GENERAL AILMENTS
Common Conditions Table
Condition
Fasting Status
Precautions
Migraine
May fast if controlled
Avoid triggers, hydrate, have rescue med at Iftar
Headache (tension)
Usually safe
Hydration, caffeine at Suhoor
Back pain
Safe
Paracetamol at Iftar/Suhoor
Arthritis
Safe
NSAIDs at Iftar only (caution with kidney)
Anemia
Caution
Iron at Iftar with vitamin C, monitor fatigue
GORD/Acid reflux
May fast
PPI at Iftar, avoid spicy/fatty, small meals
Constipation
Common in Ramadan
Increase fiber, fluids, prunes at night
Diabetes (Type 2)
See diabetes guide
Individualized plan
Common Medications Adjustment
Medication
Ramadan Timing
Painkillers (Paracetamol)
Iftar and Suhoor as needed
NSAIDs (Ibuprofen, Diclofenac)
Iftar ONLY (with food) – caution: kidney, gastric
Antibiotics
Iftar and Suhoor (complete course)
PPI (Omeprazole)
Iftar (30 min before meal)
Antacids
With Iftar and Suhoor meals
Iron supplements
Iftar (with vitamin C, avoid tea/coffee)
Calcium supplements
Suhoor (separate from iron by 2 hours)
💊 PART 10: MEDICATION ADJUSTMENT TABLES
General Medication Timing Guidelines
ONCE-DAILY MEDICATIONS
Original Time
Ramadan Timing
Morning
Iftar (sunset)
Evening
Iftar or Suhoor
Bedtime
Suhoor or Iftar
TWICE-DAILY MEDICATIONS
Original Schedule
Ramadan Schedule
Morning + Evening
Iftar + Suhoor
Morning + Bedtime
Iftar + Suhoor
THREE-TIMES DAILY
Original
Ramadan Adjustment
Morning + Afternoon + Evening
Iftar + Suhoor (consult doctor for missing dose)
May need to switch to twice-daily equivalent
🚨 PART 11: WHEN TO BREAK FAST – UNIVERSAL RED FLAGS
Absolute Indications to Break Fast Immediately
┌─────────────────────────────────────────────────────────┐
│ BREAK FAST - NO DEBATE │
├─────────────────────────────────────────────────────────┤
│ │
│ 🔴 CHEST PAIN or pressure │
│ 🔴 SEVERE HEADACHE (worst of life) │
│ 🔴 CONFUSION, slurred speech, weakness one side │
│ 🔴 SHORTNESS OF BREATH at rest │
│ 🔴 VOMITING (persistent) │
│ 🔴 DIARRHEA (>3 episodes) │
│ 🔴 FEVER >38.5°C (101.3°F) │
│ 🔴 BLOOD in vomit or stool │
│ 🔴 FAINTING or loss of consciousness │
│ 🔴 SEVERE ABDOMINAL PAIN │
│ 🔴 BLOOD GLUCOSE <70 or >300 mg/dL (diabetics) │
│ 🔴 NO URINE for >12 hours │
│ │
└─────────────────────────────────────────────────────────┘
What to Do When You Break Fast
STEP-BY-STEP:
1. Stop fasting immediately - have water/dates
2. If diabetic with low sugar - have sugar water/juice
3. Rest and recline
4. Take any emergency medications (GTN, inhaler)
5. If symptoms severe or not improving - go to ER
6. Inform doctor next day
🏥 PART 12: EMERGENCY CONTACT CARD
Cut Out and Keep in Wallet
🚨 RAMADAN EMERGENCY CARD
Name: _________________________
Medical Conditions: _________________
Allergies: _________________________
Dr. Mohammed Abdul Azeem Siddiqui
Cosmo General Hospital · Endocrinology
Emergency: [CLINIC NUMBER]
Ambulance: 997
⚠️ BREAK FAST if any RED FLAG symptoms
Ramadan 2026
📞 CONTACT & FOLLOW-UP
Pre-Ramadan Checklist
[ ] Doctor consultation completed
[ ] Medications adjusted
[ ] Blood tests done
[ ] Emergency plan discussed
[ ] Family informed
[ ] Emergency card in wallet
[ ] Glucose monitor/BP machine ready
[ ] Hydration plan set
[ ] Meal plan prepared
