The single-record write ceiling justified itself with "every one of these
routes is already wrapped in `withIdempotency`". Ten of the eleven are.
`POST /api/medications/intake` is not, and it is the one of the eleven a
native client actually loops — it is replay-tolerant for its own reason,
being an update of a named `intakeId` rather than a create. The comment
now says which is which, and adds the clause it was missing: the check
runs before the body is read, so a refused request spends the allowance
too.
The custom-symptom wrapper said a replay "answered the 409 that
uniqueness raises". There is no such 409. The row's key is minted fresh
per request and the label lives in an AES-GCM column with a per-write
IV, which can carry no unique index, so an un-keyed replay wrote a
second row with the same label — a silent duplicate in the person's own
vocabulary, up to the fifty-row cap. The wrapper is worth more than the
old sentence claimed, not less.