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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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Consumers Can Now Rely on Gluten-Free Label

By Sarah Jane Schwarzenberg, MD, FAAP, Pediatric Gastroenterologist and Hepatologist at University of Minnesota Masonic
Children’s Hospital and member of AAP’s Committee on Nutrition

As of August 5, 2014, any food product manufactured in the United States that bears the “gluten-free” claim on its label must meet new and more restrictive rules. Gluten is a group of proteins that are found in wheat, rye, barley, and some other grains.

The Food and Drug Administration has now defined the “gluten-free” as having less than 20 ppm in foods that carry this label. This is the lowest level of gluten that can be detected using currently available tools. The same standard applies to foods labeled “without gluten,” “free of gluten” and “no gluten.”

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