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David Juurlink @davidjuurlink.bsky.social · 9h

PSA: When a naturopath recommends chelation “to remove the metal from your body,” that is exactly what you should not do.

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David Juurlink @davidjuurlink.bsky.social · 23d

Join us for UofT Therapeutics Day November 1st

- drug interactions
- NSAID allergy
- within-class safety differences
- complex polypharmacy
- pharmacogenetics
- SGLT2 inhibitors
- buprenorphine

Register here: eventbrite.com/e/the-drugs-we…

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Reposted by David Juurlink

PSI Foundation @psifoundation.bsky.social · Aug 28

Drs. Jessica Kent ‪Rice @jessicakentrice.bsky.social ‬& David Juurlink @davidjuurlink.bsky.social study on trends in opioid agonist therapy retention after non-fatal #OpioidOverdose: www.psifoundation.org/funded-resea... #InternationalOverdoseAwarenessDay #IOAD2025 @sunnybrookhsc.bsky.social

Funded Research - PSI Foundation

List of projects funded by PSI Foundation.

www.psifoundation.org

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David Juurlink @davidjuurlink.bsky.social · Aug 13

Toronto-area MDs and pharmacists: Join us for Therapeutics Day 2025

- Relevant topics
- Great speakers (but also me)
- You will be fed
- You will get CE credits

Register here: tinyurl.com/mr447y5n

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David Juurlink @davidjuurlink.bsky.social · May 30

I'm not saying these "ivermectin cured my cancer" testimonials are entirely fabricated but THEORETICALLY if someone:

1) no longer had a medical license, and
2) profited from pushing ivermectin, and
3) had no qualms about lying to desperate people ...

Just putting this out there

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Reposted by David Juurlink

Therapeutics Initiative @drug-evidence.bsky.social · May 16

🚨 ICYMI - #Opioids prescribing webinar recording featuring pharmacologist @davidjuurlink.bsky.social 🚨

💊 What have we learned about #prescribing?
💊 How should we treat pain when opioids overdoses have become an intractable epidemic?
👉🏽 ti.ubc.ca/juurlink-ana...

#pain #MedEd #medsafety

Dr. David Juurlink: Relieving pain in the era of fentanyl

YouTube video by Therapeutics Initiative

www.youtube.com

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David Juurlink @davidjuurlink.bsky.social · May 8

Every time I hear someone mention tramadol

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David Juurlink @davidjuurlink.bsky.social · Apr 10

To sum up:

- Carbapenems lower VPA concentrations abruptly and dramatically

- They do this by tinkering with VPA metabolism

- Consider carbapenems in patients with severe VPA toxicity and those you expect to develop it

/end

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David Juurlink @davidjuurlink.bsky.social · Apr 10

In the second group, I start mero or erta early

It's conceptually similar to early alkalinization for ASA toxicity

/12

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David Juurlink @davidjuurlink.bsky.social · Apr 10

The second is people *expected* to get sick, generally those who ingest >300-400 mg/kg

/11

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David Juurlink @davidjuurlink.bsky.social · Apr 10

The first is easy: the sickest of the sick

If you're contemplating hemo, you should be contemplating mero or erta

As I wrote:

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David Juurlink @davidjuurlink.bsky.social · Apr 10

I wrote this review on the topic. It's not open access so I'll unpack the two scenarios where I think carbapenems should be considered.

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bpspubs.onlinelibrary.wiley.com/doi/abs/10.1...

BPS Publications

Severe valproic acid (VPA) overdose is characterized by coma (sometimes with cerebral oedema), respiratory depression, hypotension and metabolic abnormalities. Traditional management of VPA poisoning...

bpspubs.onlinelibrary.wiley.com

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David Juurlink @davidjuurlink.bsky.social · Apr 10

A few case reports describe using mero or erta for VPA toxicity, like this one

www.sciencedirect.com/science/arti...

/8

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David Juurlink @davidjuurlink.bsky.social · Apr 10

What carbapenems so is inhibit APEH, abruptly and irreversibly

The net effect?

- a dramatic INCREASE in VPA-glucuronide (which is inert and eliminated by the kidney)

- a dramatic DECREASE in VPA concentrations

/7

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David Juurlink @davidjuurlink.bsky.social · Apr 10

What's missing from that depiction is the reversibility of the lowermost pathway

Normally, the dominant metabolite (VPA glucuronide) is back-converted to VPA by acyl peptide hydrolase (APEH)

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David Juurlink @davidjuurlink.bsky.social · Apr 10

We now know why this happens. It relates to how VPA is metabolized, which is generally represented like this:

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David Juurlink @davidjuurlink.bsky.social · Apr 10

In 1997, Japanese doctors reported 3 children whose VPA levels plummeted after treatment with panipenem

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journals.lww.com/drug-monitor...

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David Juurlink @davidjuurlink.bsky.social · Apr 10

Traditional management of VPA overdose?

- GI decontamination (mainly charcoal)
- L-carnitine for ↑NH₃
- Hemodialysis in the sickest of the sick

/3

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David Juurlink @davidjuurlink.bsky.social · Apr 10

Most VPA overdoses manifest as just lethargy. But large ones (>400 mg/kg) get sick, with

- coma ± cerebral edema
- respiratory depression
- hypotension
- multiorgan dysfunction
- HAGMA
- hyperammonemia

And sometimes they die

/2

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David Juurlink @davidjuurlink.bsky.social · Apr 10

Let's talk about using carbapenem antibiotics in patients with valproic acid (VPA) poisoning

/1🧵

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David Juurlink @davidjuurlink.bsky.social · Apr 6

Returning home from an international medical conference in Vancouver. In 25 years of attending these meeting I have *never* heard so many American physicians talk so openly about possibly moving to Canada.

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David Juurlink @davidjuurlink.bsky.social · Mar 18

Not me

Ryan Radecki MD MS @www.evidencetriage.com · Mar 17

I feel like I've not used bicarbonate for hyperkalemia in an extraordinarily long while already, but who is brave enough to hold off from calcium in the face of ECG changes?
#medsky #nephsky
medicineminute.substack.com/p/the-end-to...