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Toxicological evaluation of two children diagnosed as Munchausen syndrome by proxy
Zeynep Türkmen1, Neylan Ziyalar, Itir Tari
1Department of Science, Istanbul University Institute of Forensic Sciences, Istanbul, Turkey.
Insights
Munchausen syndrome by proxy is child abuse where mothers falsify illness in children. Toxicological analysis confirmed mercury and warfarin poisoning in two cases, leading to psychiatric referrals.
Area of Science:
- Pediatrics
- Toxicology
- Child Psychiatry
Background:
- Munchausen syndrome by proxy (MSP) is a severe form of child abuse.
- It involves fabricating or inducing illness in a child by a caregiver.
- Children with MSP often face prolonged hospitalizations and extensive, invasive diagnostic procedures.
Observation:
- Two cases of toxicologically confirmed MSP are presented.
- Case 1: A 16-month-old boy with fever, cyanosis, tremor, and cardiac arrest, linked to maternal administration of mercury-contaminated fluids.
- Case 2: A 14-year-old girl with abnormal blood work and multiple hospitalizations, found to have warfarin poisoning.
Findings:
- Mercury (Hg) detected in fluids and urine of Case 1's child.
- Warfarin identified in the serum of Case 2's child.
- Both mothers were referred for psychiatric evaluation.
Implications:
- MSP should be suspected in cases with unexplained, inconsistent, or negative findings despite frequent hospitalizations.
- Psychiatric assessment of caregivers is crucial.
- Toxicological analysis is vital for confirming fabricated or induced illnesses in suspected MSP cases.
Abstract:
Munchausen syndrome by proxy is a kind of child abuse in which affected children are often hospitalized for long periods and endure repetitive, painful and expensive diagnostic attempts. We present herein two toxicologically confirmed cases of Munchausen syndrome by proxy. Case 1 is a 16-month-old male who had fever, peripheral cyanosis, tremor, and reported cardiac arrest. Symptoms recurred in the hospital when the mother administered fluids. Toxicology detected 3.5 ng/ml mercury (Hg) in the fluid and 9.4 microg Hg/g creatinine in the urine. Case 2 is a 14-year-old female who had irregular blood findings and multiple hospitalizations. Serum analysis detected warfarin. Both mothers were transferred to psychiatric care. Munchausen syndrome by proxy should be suspected when clinical/laboratory findings are negative, illness descriptions are inconsistent, and frequent hospitalization yields no diagnosis. Psychiatric evaluation and toxicological analysis are recommended.
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