Pediatric Pearls - A Pre-teen with Diffuse Weakness

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Nurses Edition Commentary

Kathy Garvin, RN and Lisa Chavez, RN
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Jay B. -

I just had this same case last week in a 16yo M. I was laughing during the episode because I also primarily thought conversion disorder when I heard the story. It wasn't until I checked his sphincter tone which was also diminished and 16 year olds generally don't fake that bit. He was found to have thyrotoxicosis with a TSH of 0.0 and a potassium of 1.5.

ilene c. -

LOL! Yes, most 16 yos undergoing unexpected rectal exam have VERY GOOD tone

Charles M. -

Another cause of weakness similar to that described in this case is chronic (organic/natural/gourmet) licorice ingestion. Over the course of my career, I saw two healthy patients (one teenager, one a woman in her early 30s) who presented after exercising with what several people thought might be a spinal compression. A lab result of K < 2.0 led to a closer history that revealed chronic licorice ingestion.

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