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MNAAP Newsletter

A Case of Elevated Liver Enzymes: Simple Virus or Suicide Attempt?

By Sarah Jane Schwarzenberg, MD, Director, Pediatric Gastroenterology, Hepatology and Nutrition, University of Minnesota Masonic Children’s Hospital and Sameer Gupta, MD, Division of Pediatric Critical Care, University of Minnesota Masonic Children’s Hospital

Case: A 15-year-old boy presented to the Emergency Department with his parents. He had been seen in an Urgent Care for vomiting and was found to have elevated liver enzymes (ALT 415, AST 475). As part of the standard panel of questions in the ED he was asked if he had thoughts of harming himself. He replied that he had such thoughts in the past, but not now. Because of this response he was questioned by a nurse and a pediatric resident with his parents out of the room. He denied self-harm, and stated he was in psychotherapy because of depression. He repeatedly denied use of acetaminophen.

His vomiting resolved after IV fluids. His liver enzymes decreased by 20 percent over 18 hours, and he was discharged with a diagnosis of viral gastroenteritis.
Two months later he attempted suicide with acetaminophen. He was hospitalized with a mild hepatopathy that quickly resolved. He admitted that the initial admission 2 months prior was the result of a similar suicide attempt with acetaminophen, during a time when he was not taking his anti-depressants.

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Screening for Mental Health Problems with the PSC-17 Tool

By Calla R. Brown, MD, Tom Scott, MD, and Iris W. Borowsky, MD, PhD

Mental health conditions are prevalent in the pediatric population, and identification and treatment at an early age can lead to improved long-term outcomes. Primary care clinics have long been promoted by the Bright Futures Guidelines for Health Supervision as the optimal site of screening for mental health conditions in the pediatric population given pediatricians’ sustained contact with children and families.

Diagnosis of mental health conditions in children through improved screening rates has been identified by the Minnesota Department of Health as a core measure in pediatrics, and there are several tools available to the general pediatrician for screening. This Minnesota goal is in line with national objectives to increase screening and treatment for mental health conditions, and Healthy People 2020 includes specific screening and treatment goals for depression in adolescents.


One of the most widely used and validated screening tools is the Pediatric Symptom Checklist-17 (PSC-17). While this tool is recommended in the state of Minnesota as a screening questionnaire for psychosocial problems in the pediatric population, screening rates for mental health conditions across the state as reported by the Minnesota Department of Health currently average around forty percent.

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AAP Committee on Substance Use and Prevention

PamGonzalez2By Pamela Gonzalez, MD

The AAP Committee on Substance Abuse (COSA) has officially changed its name to Committee on Substance Use and Prevention (COSUP). This is great news for many reasons, including the elimination of pejorative language (“abuse”).

“The Committee on Substance Use and Prevention (COSUP) produces guidance for pediatricians, state and federal government, and other stakeholders to reduce harm from substance use. This is where your key role in prevention, screening, and early intervention comes in.

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Screening Tool for Low-Income Families: Bridge to Benefits

By Rachel Tellez, MD, pediatrician at HCMC

Rachel Tellez 2-1Nearly 15 percent of Minnesota’s children live in poverty, with children of color being disproportionately affected: nearly half of African-American children, one-third of American Indian children, one-third of Hispanic children, and one-fifth of Asian children live in poverty. Living in poverty can result in poorer health outcomes for children, including negative effects on physical health, nutritional status, socioemotional development, language development and educational outcomes. Additionally, more than one-third of Minnesota children (419,000) live in low-income households that struggle to provide basic needs and opportunities resulting in similar long-term outcomes, according to Kids Count.

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New Leadership in Bloom

When I look in my backyard, it’s clear that Spring is nearly here. The tSueBerryree has bright green buds so it won’t be long. And it won’t be long until our chapter has a new president. This is my last letter as president to you, the members of the Minnesota Chapter of the American Academy of Pediatrics.

A lot has happened in these two years! Our work groups have been very energetic and a lot of activities have moved forward. You’ll be hearing more about this at our annual meeting, coming up May 20. We will be focusing on ways that we can take concrete steps to reduce health disparities for the kids that we care for. We will be talking about access to mental health services.

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