tingling or flushing of the face, nausea or vomiting,
diarrhea, and dehydration.Herbal preparations. Herbal preparations used as
diuretics have a wide range of potential adverse
effects, ranging from intensifying the effects of pre-
scription diuretics to indigestion, skin rashes, head-
ache, and diarrhea.
Alcohol. Complications associated with ethanol con-
sumption include the risks of dehydration and elec-
trolyte imbalance caused by intoxication; alcohol
abuse; trauma from alcohol-related accidents; and
interactions with other medications.
Pamabrom. Pamabrom has been reported to cause
skin rashes and dependence in a very small minority
of patients.
Parental concerns
Parents do not ordinarily need to be concerned
about children or adolescents abusing prescription
diuretics, as these drugs do not produce mood alter-
ation or relieve pain. Adolescents, however, are likely
to abuse nonprescription diuretics in relation to eating
disorders or athletic competition; one study found that
64% of adolescents diagnosed with eating disorders
were using herbal diuretics. A few adolescents may
develop caffeine-related disorders apart from eating
disorders or sports.
Eating disorders
Abuse of over-the-counter diuretics is common
among adolescents with eating disorders accompanied
by purging, although it is slightly less common than
self-induced vomiting or abuse of laxatives. Although
eating disorders are classified asmental healthprob-
lems, they can have serious lifelong digestive and
nutritional consequences, including erosion of tooth
enamel, loss of bone density leading to eventual osteo-
porosis, and ongoing problems with water retention.
Athletic competition
Numerous reports of diuretic abuse among ath-
letes in high school and college sports programs have
accumulated since the late 1980s. Abuse of OTC diu-
retics is higher among both males and females in such
weight-related sports as wrestling and rowing than
among participants in sports that do not classify ath-
letes by weight (distance running, swimming, basket-
ball, etc.). More males than females abuse diuretics at
both the high school and college levels; the average age
of initial misuse of diuretics in one sample was 15.6
years for males and 16.2 years for females. Abuse of
diuretics puts young athletes, particularly males, at
risk of dehydration, chest pains, fainting, and irregular
heart rhythms, particularly when combined with ephe-
drine or other stimulants.Caffeine dependence and intoxication
According to DSM-IV, caffeine use typically
begins in the mid-teens in the United States and Can-
ada, with levels of consumption increasing into the
early adult years (20s and 30s). Among teenagers,
caffeine use is usually higher among boys than girls,
and higher among smokers than nonsmokers. Most
fatal cases of caffeine overdose occur among adults in
their early 20s, usually as a result of taking OTC
caffeine tablets by mouth or inhaling crushed tablets.Resources
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PERIODICALS
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