What’s Your Diagnosis? Substance Use in Adolescents

Welcome to this month’s What’s Your Diagnosis Challenge!

But before we begin, check to see if you got the previous case on Emergency Department Evaluation and Management of Nonaccidental Trauma in Pediatric Patients right.

Case Presentation: Substance Use in Adolescents: Recognition and Management in the Emergency Department 

A 16-year-old girl presents with generalized abdominal pain and intractable vomiting… 

The patient has been having 5 to 6 episodes of nonbloody, nonbilious emesis for 2 days and is unable to keep down liquids or solids. The girl denies fever, chills, diarrhea, chest pain, or trouble breathing. 

The girl’s vital signs are: temperature, 37°C; heart rate, 120 beats/min; blood pressure, 135/83 mm Hg; and respiratory rate, 18 breaths/min. 

Upon further questioning privately, she admits daily marijuana use, but otherwise denies use of alcohol and other recreational drugs, as well as sexual activity. 

What are the first steps in diagnosis and treatment of this patient? 

Case Conclusion

Upon further questioning, the girl revealed that she had been using marijuana daily for a couple of years. Initial laboratory evaluation and bedside right upper quadrant ultrasound were ordered to rule out other causes, and they were negative. The girl was diagnosed with cannabinoid hyperemesis syndrome. She received IV crystalloid fluids and a dose of IV haloperidol. Initially, her symptoms improved but then recurred. She was ultimately admitted to the inpatient unit for continued IV hydration and supportive management. 

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Last Updated on November 29, 2023