title: Munchausen syndrome presenting acutely in the emergency department.
abstract: Munchausen syndrome is a rare psychiatric disorder in which patients purposely harm themselves to gain medical attention. These patients may present to unsuspecting emergency department (ED) staff members with life-threatening signs and symptoms. We report a case of Munchausen syndrome in which a young man with ties to the medical community and a history of substance abuse presented to our ED with refractory hypoglycemia and a dilated right pupil. The patient required large amounts of dextrose, endotracheal intubation, mechanical ventilation, and admission to the intensive care unit. Further investigation revealed that he had purposely injected himself with a large dose of insulin and instilled atropine drops in his right eye for the purpose of seeking hospitalization. The history, details, diagnosis, treatment, and prognosis are discussed in the context of this case.
authors.affiliation: Department of Emergency Medicine, San Francisco General Hospital, San Francisco, California 94110, USA.
authors.forename: S W
authors.initials: SW
authors.lastname: Bretz
authors.forename: J R
authors.initials: JR
authors.lastname: Richards
mesh_terms: D000208:Acute Disease; D000328:Adult; D001285:Atropine / Q000009:adverse effects*; D003937:Diagnosis, Differential; D004638:Emergency Treatment / Q000379:methods*; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced*; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D007328:Insulin / Q000009:adverse effects*; D008297:Male; D009110:Munchausen Syndrome / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D015878:Mydriasis / Q000139:chemically induced*; D009184:Mydriatics / Q000009:adverse effects*; D011570:Psychiatry; D012017:Referral and Consultation; D019966:Substance-Related Disorders / Q000150:complications* / Q000175:diagnosis / Q000628:therapy
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D009184:Mydriatics; D001285:Atropine