Permanent Brain Damage Following Acute Clonidine Poisoning in Munchausen by Proxy

A child presented with recurrent episodes of lethargia for which he underwent several hospital admissions and investigations. A further episode culminated in respiratory arrest and hypoxic ischemic encephalopathy with permanent mental regression. Eighteen months later the mother was discovered while providing clonidine pills to the child; the mother appears to feature a Munchausen syndrome by proxy.

Clonidine - Poisoning - Munchausen by proxy

References

• 1 Barkovich A J. Metabolic and destructive brain disorders. Barkovich AJ Pediatric Neuroimaging. New York; Raven Press 1990: 35-75
• 2 Erickson S J, Duncan A. Clonidine poisoning - an emerging problem: epidemiology, clinical features, management and preventative strategies.  J Paediatr Child Health. 1998;  34 280-282
• 3 Falini A, Barkovich A J, Calabrese G, Origgi D, Triulzi F, Scotti G. Progressive brain failure after diffuse hypoxic ischemic brain injury: a serial MR and proton MR spectroscopic study.  Am J Neuroradiol. 1998;  19 648-652
• 4 Fiser D H, Moss M M, Walker W. Critical care for clonidine poisoning in toddlers.  Crit Care Med. 1990;  18 1124-1128
• 5 McClure R J, Davis P M, Meadow S R, Sibert J R. Epidemiology of Munchausen syndrome by proxy, non-accidental poisoning, and non-accidental suffocation.  Arch Dis Child. 1996;  75 57-61
• 6 Maggi J C, Iskra M K, Nussbaum E. Severe clonidine overdose in children requiring critical care.  Clin Pediatr. 1986;  25 453-455
• 7 Maloney M J, Schwam J S. Clonidine and sudden death.  Pediatrics. 1995;  96 1176-1178
• 8 Meadow R. Munchausen syndrome by proxy. The hinterland of child abuse.  Lancet. 1977;  13 343-345
• 9 Nichols M H, King W D, James L P. Clonidine poisoning in Jefferson County, Alabama.  Ann Emerg Med. 1997;  29 511-517
• 10 Olsson J M, Pruitt A W. Management of clonidine ingestion in children.  J Pediatr. 1983;  103 646-650
• 11 Wiley J P. Difficult diagnosis in toxicology.  Pediatr Clin North Am. 1991;  28 725-737