iiinova — where your digital self keeps evolving

David Juurlink @davidjuurlink.bsky.social · 22/05/2026

"Good morning, it's nice to meet you. This is why I'm a dog person."

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David Juurlink @davidjuurlink.bsky.social · 22/05/2026

When the medical student is unusually thorough

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David Juurlink @davidjuurlink.bsky.social · 26/04/2026

Hyperbaric oxygen for CO poisoning in one paragraph bpspubs.onlinelibrary.wiley.com/doi/epdf/10....

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EMCrit Blog and Podcast @emcrit.bsky.social · 17/04/2026

COHb of 32% — should you dive this patient? The answer is more complicated than your tox textbook lets on. New EMCrit with Dave Juurlink unpacking why it is not the slam dunk you were taught. [#FOAMed for a bit] emcrit.org/423

emcrit.org

EMCrit 423 - Hyperbaric Therapy for Carbon Monoxide Poisoning?

HBOT for CO???

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David Juurlink @davidjuurlink.bsky.social · 28/03/2026

Entering our neuro ICU. Someone needs to update this photo.

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David Juurlink @davidjuurlink.bsky.social · 24/03/2026

Remember all the talk of healthy young people dying suddenly after COVID-19 vaccination? Our new study in @plosmedicine.org shows there's absolutely nothing to that. journals.plos.org/plosmedicine...

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Paul Gowder @gowder.io · 04/03/2026

wait wait WHAT? Apparently a "medical journal" in canada has been publishing fictionalized case reports for decades without indicating to its readers that they were fictionalized... retractionwatch.com/2026/03/03/c...

retractionwatch.com

A medical journal says the case reports it has published for 25 years are, in fact, fiction

A Canadian journal has issued corrections on 138 case reports it published over the last 25 years to add a disclaimer: The cases described are fictional. Paediatrics & Child Health, the journal…

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David Juurlink @davidjuurlink.bsky.social · 04/03/2026

Here’s the New Yorker story that started this ball rolling bsky.app/profile/newy...

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David Juurlink @davidjuurlink.bsky.social · 04/03/2026

It’s no wonder people distrust science. Let's see if @oxfordunipress.bsky.social and the Canadian Paediatrics Society do the right thing and retract this fabricated report. cc: @publicationethics.bsky.social

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David Juurlink @davidjuurlink.bsky.social · 04/03/2026

Among these? The most detailed report of neonatal opioid toxicity from breastfeeding ever published. One small problem: It's pharmacologically impossible.

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David Juurlink @davidjuurlink.bsky.social · 04/03/2026

The official journal of the Canadian Paediatric Society has just acknowledged that more than 100 of its case reports are fabricated. Incredible reporting from @retractionwatch.com retractionwatch.com/2026/03/03/c...

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David Juurlink @davidjuurlink.bsky.social · 10/02/2026

Why is a 20-year-old study "still under fire"? Because: - it was wrong - the lead author lied to conceal it - millions of women and infants were harmed - other death investigations were misled - when shown this, major institutions looked away www.cbc.ca/news/health/...

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Monique Morrissey @moniquemorrissey.bsky.social · 05/02/2026

This story is jaw dropping: one very bad actor, but also scientific journals (the Lancet!), a medical examiner, a hospital, & other establishment pillars who were taken in & now refuse to correct the record. Victims include not just baby who died but others removed from parents based on bad science.

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David Juurlink @davidjuurlink.bsky.social · 04/02/2026

For nearly 20 years, breastfeeding women have been cautioned against codeine, based largely on a single case report. The Lancet has now issued an Expression of Concern about that paper.

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John Michael McGrath @jm-mcgrath.bsky.social · 28/01/2026

Absolutely wild story even for those of us who know the context of Motherisk (!)

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Brandy Zadrozny @brandyzadrozny.bsky.social · 27/01/2026

This story is so wild and so well told. I woke my husband up gasping at the "we made it up" part.

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David Juurlink @davidjuurlink.bsky.social · 26/01/2026

I’ve spent 15 years challenging a flawed explanation for an infant’s death. Credit to The New Yorker for patient investigative journalism that corrected the record when institutions did not.

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David Juurlink @davidjuurlink.bsky.social · 08/01/2026

New rule: If you order the D-Dimer, you have to interpret the D-Dimer

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David Juurlink @davidjuurlink.bsky.social · 30/12/2025

For those contemplating a detox or cleanse in the new year, here’s a toxicologist’s explanation of how they work: They don't.

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David Juurlink @davidjuurlink.bsky.social · 27/10/2025

We've all seen firsthand how well opioids can work when first given. But they are at their pharmacologic best in the initial days of treatment. Continue them for weeks, months, or years and the calculus becomes progressively less favourable.

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David Juurlink @davidjuurlink.bsky.social · 09/10/2025

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 · 16/09/2025

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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David Juurlink @davidjuurlink.bsky.social · 13/08/2025

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 · 30/05/2025

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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Therapeutics Initiative (TI) @drug-evidence.bsky.social · 16/05/2025

🚨 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

youtube.com

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

YouTube video by Therapeutics Initiative

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David Juurlink @davidjuurlink.bsky.social · 08/05/2025

Every time I hear someone mention tramadol

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David Juurlink @davidjuurlink.bsky.social · 10/04/2025

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 · 10/04/2025

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 · 10/04/2025

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 · 10/04/2025

The first is easy: the sickest of the sick If you're contemplating hemo, you should be contemplating mero or erta As I wrote: /10

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David Juurlink @davidjuurlink.bsky.social · 10/04/2025

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 · 10/04/2025

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 · 10/04/2025

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) /6

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David Juurlink @davidjuurlink.bsky.social · 10/04/2025

We now know why this happens. It relates to how VPA is metabolized, which is generally represented like this: /5

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David Juurlink @davidjuurlink.bsky.social · 10/04/2025

In 1997, Japanese doctors reported 3 children whose VPA levels plummeted after treatment with panipenem /4 journals.lww.com/drug-monitor...

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David Juurlink @davidjuurlink.bsky.social · 10/04/2025

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 · 10/04/2025

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 · 10/04/2025

Let's talk about using carbapenem antibiotics in patients with valproic acid (VPA) poisoning /1🧵

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David Juurlink @davidjuurlink.bsky.social · 06/04/2025

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 Frum @davidfrum.bsky.social · 06/03/2025

It takes a unique kind of genius to fuck up the US-Canada relationship.

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David Juurlink @davidjuurlink.bsky.social · 01/01/2025

Not starting a detox today because I have a liver and kidneys

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David Juurlink @davidjuurlink.bsky.social · 29/12/2024

For those contemplating a detox or cleanse in the new year, here’s a toxicologist’s explanation of how they work: They don’t

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David Juurlink @davidjuurlink.bsky.social · 28/12/2024

I don’t know who needs to hear this but short, focused progress notes are better than long, detailed progress notes. By a mile.

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