2025 – PAGE 73 – ADOLESCENT MEDICINE

DRUG SCREENING

Drug screening in the office should always be voluntary.

PEARL: Parents should be encouraged to have “the talks” with kids around the age of 10. This includes an open discussion about sex and illicit drugs.

EXOGENOUS ANABOLIC STEROIDS

If taken by IM injection, exogenous anabolic steroids are detectable for 6 or more months. If they are taken orally, then they are detectable for 1 month or less. Exogenous growth hormones give a similar laboratory and side effect profile as exogenous anabolic steroids, but they are not detectable as a substance of abuse. Side effects of exogenous anabolic steroids include the following:

• ­Girls: Hirsutism, deep voice, early closure of growth plates
• ­Boys: Gynecomastia, high voice, hypogonadism, acne, oligospermia
  • MNEMONIC: Girls start to look/sound like boys and vice versa
• ­Both: Liver dysfunction, low HDL, high LDL, emotional lability, HTN.

EATING DISORDERS

NOTE: Eating disorders are common at times of transition for overachievers. In general, weight loss should not exceed 3 lbs./week.

ANOREXIA

In patients with anorexia, look for laxative abuse, diuretic abuse (supportive labs include hypOkalemia, alkalosis, and HIGH FeNa!), emesis, bradycardia, ST depression, prolonged QT, Ventricular Tachycardia (V-tach), hypothermia, amenorrhea, and orthostasis. The patient’s history must include a restriction of energy intake, an intense fear of gaining weight, and body image disturbance. There are two subtypes: restricting type and binge-eating/purging type per the DSM-V.

MNEMONIC: ProLONGed QT and ST Depression = “A LONG-faced anorexic QT/Cutie is a little too Skinny/Thin… Even so, she still can’t stop being DEPRESSED because her body just doesn’t look right when she looks in the mirror!”

MNEMONIC: Bradycardia and Hypothermia = Just imagine that the super skinny anorexic girl’s body is so STARVED, that her heart beats slow and her body produces LESS HEAT ENERGY (to go into a calorie conservation mode).

PEARL: Anorexia can cause secondary amenorrhea. Suspect anorexia as the possible cause of amenorrhea if the patient has not had a period for 3 months. Anorexia can cause bradycardia, orthostatis, and hypothermia.

BULIMIA

Bulimia = Overeating + Induced emesis. Patients tend to be a little overweight. Signs and symptoms include enamel erosion (from the acid), enlarged parotids, elevated amylase, irregular menses, hypOkalemic hypOchloremic metabolic ALKalosis and lanugo hair. Any patient with dehydration, an abnormal EKG or suicidal ideation in the setting of bulimia should be hospitalized.

REFEEDING SYNDROME

Refeeding syndrome can cause hypOkalemia, hypOmagnesemia, hypOphosphatemia, rhabdomyolysis, delirium due to thiamine deficiency, and seizures.

PEARLS:

• ­Excessive vomiting, chronic laxative use, diuretics = hypOkalemic hypOchloremic metabolic ALKALOSIS
• ­Refeeding syndrome: “When the body is in starvation mode, ATP is not being made. When sources of phosphorus (food) are reintroduced, too much is taken up to restart making ATP therefore resulting in dangerously low hypophosphatemia.”