title: Toxicological evaluation of two children diagnosed as Munchausen syndrome by proxy.
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.
authors.affiliation: Department of Science, Istanbul University Institute of Forensic Sciences, Istanbul, Turkey.
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Türkmen
authors.forename: Neylan
authors.initials: N
authors.lastname: Ziyalar
authors.forename: Itir
authors.initials: I
authors.lastname: Tari
authors.forename: Selda
authors.initials: S
authors.lastname: Mercan
authors.forename: Sinan Mahir
authors.initials: SM
authors.lastname: Kayiran
authors.forename: Dicle
authors.initials: D
authors.lastname: Sener
authors.forename: Salih
authors.initials: S
authors.lastname: Cengiz
authors.forename: Necla
authors.initials: N
authors.lastname: Akçakaya
mesh_terms: D000293:Adolescent; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008630:Mercury Poisoning / Q000175:diagnosis*; D009035:Mothers / Q000523:psychology*; D016735:Munchausen Syndrome by Proxy / Q000175:diagnosis*; D014859:Warfarin / Q000506:poisoning*
chemical_list: D014859:Warfarin