The Turkish Journal of Pediatrics 2012 , Vol 54 , Num 3
Toxicological Evaluation of Two Children Diagnosed as Munchausen Syndrome by Proxy
Departments of 1Science, and 2Social Sciences, İstanbul University Institute of Forensic Sciences, 3Department of Psychology,
Aydın University Faculty of Arts and Sciences, 4Department of Pediatrics, American Hospital, and 5Department of Pediatrics, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
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 µg 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. Keywords : child abuse, Munchausen syndrome by proxy, psychopathology, toxicological analysis.

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