Purpose: Hypokalemia is a known medical complication inadolescents with Eating Disorders (ED) but literature isscarce on the treatment. This study evaluates some char-acteristics, complications and the treatment of adolescentgirls hospitalized for hypokalemia with ED.Methods: This retrospective study includes all girls hospi-talized in 2 University Hospitals between 1993 and 2003 forhypokalemia (K� � 3.5 mmol/l) as a complication of ED.A standard grid was used to collect the data from themedical records. Descriptive statistics, Chi-square and T-test were used to analyse the data.Results: A total of 28 adolescent girls were included in thestudy. Of these, 24 (86%) had been diagnosed as DSM-IVAnorexia Nervosa, bulimia�purging subtype. At their firsthospitalisation, mean age was 16.7 years. The 28 adoles-cents had a total of 45 inpatient treatment episodes forhypokalemia and the results for these episodes are nowpresented. Mean BMI was 15.8 kg/m2 on admission. In64% of the episodes, girls lost weight in the previousmonth, in 71% they admitted vomiting more than oncedaily, in 11% they admitted laxative use, and in 18% girlswere on a potassium supplement. Mean K� on admissionwas 2.6 mmol/l (range of 1.7-3.4) and in 42%, hypokalemiawas severe (K� � 2.5 mmol/l). Neither weight variation inthe past month nor purging frequency had a significantimpact on level of hypokalemia. A total of 22 electrocar-diograms were done (49% of episodes) and 13 (59%)showed abnormalities (12 sinusal bradycardia, 2 QT elon-gation, 1 T wave depression, 1 U wave and 1 ST depres-sion). Out of the 45 episodes, 3 (7%) girls were admitted tothe intensive care unit for hypokalemia with a mean K� of2.0 mmol/l and a mean observation time of 12 hours.Complications were observed in 49 % of all episodes (18sinusal bradycardia, one dehydration, 5 dental lesions and9 minor complications). Upon admission, for the 45 epi-sodes, treatment was as follows: IV K� for 27 (60%), oralK� for 7 (16%), IV and oral K� for 9 (20%) and nosupplement for 2 (4%) episodes. All girls with a K� � 2.5mmol/l upon admission received IV supplementation. Atthe end of hospitalisation, mean total K� supplementationwas 3.49 mEq/kg (range of 0.4-7.5) for the 3 days assessed.Mean duration for normalization of serum K� was 31.9hours and no significant difference was seen in relationwith neither the total dose of K� supplementation givennor the severity of hypokalemia. However, girls withkalemia � 2.5 mmol/l received more potassium supple-ment than those with kalemia � 2.5 mmol/l (mean of 4.46mEq/kg vs 2.73 mEq/kg) (p � 0.001).Conclusions: Even in the presence of severe hypokalemiaat admission, most girls having purging behaviour as partof their ED have minor complications only. No life threat-ening complications were seen. Although parenteral routeis used for girls with severe hypokalemia, there is noevidence that it influences the duration of K� normaliza-tion. Given those results and the limitations of our retro-spective cohort, prospective studies should be directed atthe safest method of kalemia normalization.

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BEYOND “I DON’T KNOW”Karen Caines, M.S.N., A.P.N., Mary Jo Gilmer, Ph.D.,M.B.A., R.N. School of Nursing, Vanderbilt University, Nashville,TN.

Purpose: Inductively examining a culture of interest iscontingent upon learning the language specific to thatculture. Early adolescent girls, however, have been evi-denced to lose their confidence in knowing and to conse-quently answer open-ended questions with the blanketstatement, “I don’t know”. In conducting this pilot ethno-graphic study, we aimed to understand how to ask open-ended interview questions to capture the culture-specificlanguage of early adolescent girls participating in orga-nized swimming. With the larger ethnography, we aim toexamine sociocultural protective factors that buffer exces-sive weight concerns in this micro-culture of girls. Orga-nized swimming is a micro-culture where girls’ developingbodies are visible; they participate in a potential compe-tence-building activity; and they interact with same-sexpeers, opposite-sex peers, and non-related adults.Methods: A group of early adolescent girls similar to thoseanticipated to participate in the larger study was purpose-fully sampled from a community fitness organizationlocated in a metropolitan area of the Midwest. Aftergaining entree and IRB approval, the PI began participat-ing in co-ed swim practices for youth ages 6-15 years.Participating on the swim team gave the PI an opportunityto forge relationships with the swimmers before conduct-ing individual semi-structured interviews. Over 8 weeks ofswimming with the team, participants were sequentiallyrecruited based on age variation, in both years and months.Four girls, ages 11.0 – 12.75 years, participated. Parentalconsent rate was 80%; of those, participation rate was100%. Participants were recruited until the refined ques-tions captured the cultural domains of interest.Results: Initial answers to questions consisted of “I don’tknow”. Probes utilizing information gleaned from culturalimmersion were found to be pivotal in guiding interviewresponses beyond answers of “I don’t know”. Participantsshowed efficacy in answering open-ended questions whenquestions were recast in their cultural terms. Use of cul-tural probes led to three key revisions being made to theoriginal interview guide. The questions were reordered tocollect culturally specific information before more gener-alized information. Questions containing terminology for-eign to the participants (e.g., masculine) were dropped.Contrast questions were reworded employing culturalterms observed during practice sessions as well as offeredin their responses.Conclusions: Culture immersion, to the point of forgingrelationships with the participants, facilitated the revision ofquestions. The PI was able to guide girls in their ways ofknowing and thus, the language of the micro-culture oforganized swimming from being immersed in adolescentgirls’ culture. Forging relationships with study participants

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prior to conducting interviews afforded the PI the ability tolearn the language, and thus, the behavioral expectations ofthe culture. Through serial refinement, the interview guidewas revised to effectively examine the cultural domains ofprotective factors buffering excessive weight concerns.

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MEDICATIONS AND DRUGS CONSUMPTIONAMONG ADOLESCENT GIRLS AND BOYS WITHWEIGHT AND EATING CONCERNC. Chamay-Weber, M.D., F. Narring, M.D., M.S.C.Adolescent Health Unit, Geneva University Hospital, Switzerland.

Purpose: There is a current controversy regarding thefrequency of substance-use in adolescents with partial andfull eating disorder. The purpose of this study is to assessif adolescents with excessive weight and eating concern(WEC) use medications, legal and illegal substances morefrequently, and if there is a gender difference.Methods: As a part of a 2002 Swiss Multicenter Survey onHealth, 7372 (16 - 20 year-old) adolescents attending schoolwere assessed by a self-administered anonymous question-naire with questions focusing on eating behaviour, using theWeight and Eating Concern Inventory (WECI) and otheritems on general health and behaviours. Responders with ahigh (�3) score on the WECI questionnaire were assessed asto the frequency of their use of medications and substances.Results: Girls and boys with excessive weight and eatingconcerns (WEC) take more medications than others. Girlstake medications more frequently for constipation (OR 5.7,IC (95%): 2.1-8.7), sleep (OR 3.1, IC (95%): 1.49-6.44) andstress/anxiety (OR 2.9, IC (95%): 1.9-4.35). Boys take onlymore medications for constipation (OR 9.1, IC (95%):1.11-75.4). For substance-use, WEC girls take more tobacco(OR 1.9, IC (95%): 1.6-2.3), cannabis (OR 1.66, IC (95%):1.29-2.14), ecstasy (OR 4.4, IC (95%):1.67-11.7) and cocaine(OR 4.17, IC (95%):1.17-14.8). For WEC boys, results aresignificant only for tobacco (OR 1.7, IC (95%):1.07-2.8).Alcohol abuse is also more frequent in WEC girls (OR 1.84,IC (95%) 1.103-3.08), but not in boys.Conclusions: WEC Girls and boys have a differentialpattern of substances consumption: girls use medicationsand substances more frequently; whereas WEC boys doesnot differ from other youths.Support: Geneva University Hospital, Switzerland.

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ANOREXIA NERVOSA: WEEKLY WEIGHT GAIN INHOSPITALIZED CHILDREN AND ADOLESCENTSMae S. Sokol, MD, Jessica R. Kaufman, BS, Mel Hall, JoyceM. Stoural, BSN. Eating Disorders Program, Children’s Hospitaland Creighton University School of Medicine, Omaha, Nebraska.

Purpose: To examine weekly weight gain of adolescentanorexic patients in our inpatient Eating Disorders Pro-gram. Our program is a specialty eating disorders unitdesigned for children and adolescents under 22 years of

age. The inpatient program provides a multidisciplinarytreatment plan. In the treatment of Anorexia Nervosa (AN)in children and adolescents, weight gain is crucial forrecovery. Medical complications may result from weightgain that occurs too slowly or too quickly. Weight recoverythat occurs too slowly does not fully counter the ongoingeffects of malnutrition. Weight gain is particularly impor-tant in youngsters to help them grow and develop. Incontrast, weight gain that occurs too quickly may producemedical complications such as the re-feeding syndrome.Therefore, knowledge of what constitutes a healthy rate ofweight gain in anorexic youngsters is essential.Method: A retrospective chart review of 132 patientsassessed weekly weight gain through examination of baseweight (weight the morning after admission), weight atdischarge, and length of stay. Of these patients, 122 werefemale, 10 were male. The average patient age was 15.5years. Patients had a DSM-IV-TR diagnosis of AN andwere hospitalized in the Eating Disorders Program inpa-tient unit.Results: Patients participating in the inpatient programbetween April 2002 and June 2005 gained an average of 2.4pounds per week. Average length of stay was 28.9 days.Conclusions: Patients in the Eating Disorders Programinpatient unit averaged a healthy rate of weight gain withno significant adverse effects. This is consistent with theweekly weight gain of two to three pounds per weekrecommended in the Practice guideline for the treatment ofpatients with eating disorders (The American PsychiatricAssociation Work Group on Eating Disorders, 2000) and iscomparable to other eating disorders specialty treatmentprograms.

The American Psychiatric Association Work Group onEating Disorders. Practice guideline for the treatment ofpatients with eating disorders (revision), Am J Psychiatry,2000; 157 (suppl 1):1-39.

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IMPACT OF PHYSICAL ACTIVITY ON BONEULTRASOUND MEASUREMENTS INADOLESCENTSKeith J. Loud, M.D.,C.M., M.Sc., Andrea A. Pettinato, M.D.,Stephanie K. Bristol, B.S., Catherine M. Gordon, M.D., M.Sc.Children’s Hospital Medical Center of Akron, Ohio and Children’sHospital Boston, Massachusetts.

Purpose: Physical activity may be the optimal way to increasebone mineral acquisition during the adolescent years, whenpeak bone mass, the strongest predictor of future osteoporo-sis risk, is attained. Quantitative ultrasound (QUS) is anappealing technique to evaluate bone because of its speed,portability, and absence of ionizing radiation. The purpose ofthis study was to evaluate the relationship between speed ofsound (SOS) measurements via QUS and physical activitylevels in American adolescents.Methods: 151 otherwise healthy adolescents and youngadults were recruited during routine visits to an urban

160 Abstracts / 38 (2006) 137–163