Application of Pharmacokinetics in the Diagnosis of Chemical Abuse in Münchausen Syndrome by Proxy

Abstract

The case of a preschooler who was chemically abused in Münchausen syndrome by proxy is presented. Though there were many clinical characteristics that raised suspicions of this syndrome, the definitive diagnosis was made by the application of pharmacokinetics during a hospital admission. This is the first reported use of this diagnostic approach to confirm this elusive disorder. Standard pharmacological equations can be used to provide this information from pharmacokinetic data which are readily available in most hospital settings.

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References

Shnaps Y. , Frand M. , Rotem Y. , Tirosh M. The chemically abused child. Pediatrics 1981 ;68:119-21.

Jones JG , Butler HL , Hamilton B. , Perdue JD , Stern HP , Woody RC Münchausen syndrome by proxy. Child Abuse Negl 1986;10:33-40.

Zumwalt RE , Hirsch CS Subtle fatal child abuse. Hum Pathol 1980;11:167-74.

Densen-Gerber J. The forensic pathology of drug-related child abuse. Leg Med 1978;135-47.

Morselli PL , Bossi L. Carbamazepine. Absorption, distribution and excretion. In: Woodbury DM , Penry JG , Pippenger CE , eds. Antiepileptic Drugs. New York: Raven Press, 1982;465-82.

Wagner JG Linear pharmacokinetic equations allowing direct calculation of many needed pharmacokinetic parameters from the coefficients and exponents of polyexponential equations which have been fitted to the data. J Pharmacokinet Biopharm 1976;4:443-67.

Rogers D. , Tripp J. , Bentovim A. , Robinson A. , Berry D. , Goulding R. Non-accidental poisoning: An extended syndrome of child abuse. Br Med J 1976;1:793-6.

Meadow R. Munchausen syndrome by proxy: The hinterland of child abuse. Lancet 1977;2:343-5.

Meadow R. Munchausen syndrome by proxy. Arch Dis Child 1982;57:92-8.

10.

Meadow R. Fictitious epilepsy. Lancet 1984;2:25-8.

11.

Verity CM , Winckworth C. , Burman D. , Stevens D. , White RJ Polle syndrome: Children of Münchausen. Br Med J 1979;2:422-3.

12.

Ackerman NB , Strobel CT Polle's syndrome: Chronic diarrhea in Münchausen's child. Gastroenterology 1981; 81:1140-2.

13.

Henriksen O. , Johannessen SI , Munthe-Kaas AW How to use carbamazepine. In: Morselli PL , Pippenger CE , Penry JK , eds. Antiepileptic Drug Therapy in Pediatrics . New York: Raven Press, 1983;237-43.

14.

Rey E. , d'Athis P. , de Lauture D. , Dulac O. , Aicardi J. , Olive G. Pharmacokinetics of carbamazepine in the neonate and in the child. Int J Clin Pharmacol Biopharm 1979;17:90-6.

15.

Rane A. , Bertilsson L. Kinetics of carbamazepine in epileptic children. In: Johannessen SI , Morselli PL , Pippenger CE , Richens A , Schmidt D , Meinardi H , eds. Antiepileptic Therapy: Advances in Drug Monitoring. New York: Raven Press, 1980;49-54.