1. Inspite of better and safer drugs being made available, unfortunately digoxin is still the most commonly used medicine for heart failure in clinical practice. And this has been endorsed by you by keeping digoxin at first place among all. Interestingly later on you have mentioned ACEi as first line drug(1).

2. For hypertension, how much time one should wait, if BP is not being controlled by one drug, before adding the second one.

3. My last and most serious concern is regarding dopamine. Indications of dopamine listed are – to improve renal perfusion, birth asphyxia and myocardial ischemia. Renal dose of dopamine is obsolete(2), rather it may be harmful. For remaining two indications references given are of 1978 and 1979! Millions of gallon of water has passed under the bridge since than. Dopamine, now, known to be most tachy-arrhythmogenic among all vasopressors(3), then how this drug can be indicated for myocardial ischemia?

4. Dopamine reduces gastric mucosal pH, adversely affects blood flow at microcirculation level, increases pulmonary shunt and causes immunosuppeession then perhaps it would be more detrimental to the asphyxiated babies.

5. Management algorithm for septic shock describes only hypotensive patients. Hypotension occurs very late and represents uncompensated state. Whereas in pediatric septic patients normotensive, low cardiac output, high SVR shock is more common(4). Drug recommended for such shock is dobutamine(4). For treatment of pediatric hypotensive shock though many authorities still recommend dopamine as the first line drug, but its age related insensitivity(5) and if not superior than at least similar hemodynamic profile of norepinephrine makes norepinephrine a preferred choice.