Poisoning in Munchausen Syndrome by Proxy, Part 7: Conclusion and Next Steps

In this series, I discussed the common types of Munchausen Syndrome by Proxy (MSbP) poisoning, and related my own experience with vitamin poisoning. In this post, I will recommend next steps for studying MSbP poisoning.

Research Suggests Public Health is Failing

As I said in my first post in this series, I reviewed 87 case studies of MSbP poisoning from 1965 through 2015. These were all that we could identify in the scientific literature from all countries in all languages. As you can see, they are relatively evenly distributed throughout the time periods.

Distribution of MSbP Poisoning Articles

The recommendations at the end of each of the articles suggest that clever and creative toxicology and observant clinical thinking are necessary to catch these cases. But this chart suggests over 40 years, nothing has actually be done to prevent these cases.  They are just as prevalent in the literature.

From Poisoning to Policy

In the cases of these victims, the sooner the diagnosis of poisoning, the better. Hence, the revelation to even do a toxicology panel of any type usually takes place after a suspicion of MSbP. Perhaps an “MSbP toxicology panel” should be proposed which includes the top causes of poisoning in MSbP:

  • Tranquilizers and anti-depressants – especially ones the suspected perpetrator can access
  • Insulin – including oral diabetic pills and injectable insulin
  • Ipecac – especially in cases of intractable vomiting
  • Salt – considering both oral, intravenous, and feeding tube administration
  • Laxatives and diet pills – especially in cases of intractable diarrhea
  • Warfarin – especially in cases of bleeding of unknown etiology
  • Caustics – especially in cases of esophageal trauma
  • Other substances the suspected perpetrator can access, especially medications in all forms – tablet, liquid, and injectable

Rock Branch Cemetary

The scientific literature on MSbP poisoning should stop being a parade of case studies. Instead, there should be discussion of policies that should be put in place at hospitals to immediately do the “MSbP toxicology panel” if indicated. Criteria should be put in place so this panel is automatically done when certain presentations arise, especially in the pediatric setting.

Only with the commitment from the highest level of hospital administration can MSbP poisoning in the hospital be prevented through the development and enactment of a toxicology panel policy.

Interested in MSbP Policy?

Here is an example from the Arizona Department of Child Safety.

Photograph by Natalie Maynor.



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