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David Juurlink

6 Jul 20, 5 tweets, 3 min read

@JAMA_current

This thread of drug-specific tips has generated a series of podcasts with @JAMA_current's Ed Livingston (@ehlJAMA). I'll append them here as they are released.

https://twitter.com/DavidJuurlink/status/1145489525751369732

First up: penicillin allergy edhub.ama-assn.org/jn-learning/au…

@JAMANetwork

And here's @JAMANetwork excellent resource on penicillin allergy testing edhub.ama-assn.org/jn-learning/pa…

Next up: PPI-induced acute kidney injury edhub.ama-assn.org/jn-learning/au…

@ehlJAMA

Here, @ehlJAMA and I discuss potential complications of SSRI antidepressants, including impaired hemostasis, hyponatremia, drug interactions, dependence/withdrawal and serotonin syndrome edhub.ama-assn.org/jn-learning/au…

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David Juurlink

@DavidJuurlink

5 Mar

Carbapenem antibiotics reduce valproic acid (VPA) concentrations quickly and dramatically

Why does this happen?

/1

The carbapenem-VPA interaction was first described in 1997

Here, an 8-year-old girl with a seizure disorder and pneumonia is treated with panipenem

Thereafter, her [VPA] falls from 30.1 µg/mL (209 µM) to 1.53 µg/mL (11 µM)

academic.oup.com/jac/article/39…

/2

There are many similar reports, all with the same theme:

A rapid, dramatic drop in [VPA], often accompanied by a loss of seizure control

journals.lww.com/drug-monitorin…

/3

Read 11 tweets

David Juurlink

@DavidJuurlink

7 Jan

This report of a physician who died after receiving COVID vaccine offers a useful lesson in the importance of thinking more critically about does and what does not constitute a drug reaction.

/1
usatoday.com/story/news/hea…

Briefly, the MD noticed petechiae (tiny areas of bleeding into the skin, as seen in image) 3 days after vaccination. He was diagnosed with ITP (immune thrombocytopenic purpura).

People with ITP have profoundly low platelets and can bleed spontaneously as a result.

/2

The temptation to blame the vaccine is understandable: we’re hypervigilant about the safety of new drugs (especially high-profile ones employing a novel technology), and the timing seems like a slam dunk.

But step back for a moment.

/3

Read 10 tweets

David Juurlink

@DavidJuurlink

18 May 19

I'd like to share some reflections on the death of a patient. I’ve thought about her a lot.

She gave me explicit consent to tweet the details of her case, about four hours before she died. Her hope was that someone might benefit from her experience.

/1

She came to hospital as octogenarians often do: with generalized weakness, falls, poor oral intake, fever, hypotension.

Her WBC was 17,000. Blood cultures grew E. coli.

Sepsis. Fixable enough.

/2

But she also complained of pain in her groin and thigh. It was new, progressive and debilitating.

Even moving around in her hospital bed was agonizing.

/3

Read 22 tweets

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