Unwitnessed sulphonylurea poisoning in a healthy toddler

Dilemma of diagnosing sulphonylurea overdose in children: deliberations and considerations before reaching a diagnosis

“…The fact that the late grandfather was a diabetic and was on gliclazide tablets being completely forgotten by the family members emphasises the importance of actively exploring the history of diabetes in first and second-degree relatives, living or dead 10. This would have led to a correct diagnosis without the need for extensive investigations such as CT scan of the abdomen in our patient.…”

Patient-Centered Medicine and Prevention of Munchausen Syndrome by Proxy

“…While individual clinicians have sought to try to approach MSbP from a more public healthand patient-centered perspective [24,25,57,58], their attempts are thwarted by the lack of a patient-centered perspective in the actual case reports and case series reports that are published in the scientific literature that provide the evidence base that informs them. Most case reports, from the history of reporting on this condition to the present time, focus on horrific medical details of the abuse, rather than the medical system's contribution to it [59][60][61][62]. For example, a 2015 report found that a mother was inserting real stones in her male child's urethra to try to convince clinicians that he had kidney stones; this child was returned to his family and no follow-up was done to see if the child was eventually killed [63].…”

“…It is common to see in these case reports that children are returned to the home of the perpetrator, even though there is no curative treatment for MSbP behavior, and the likelihood of the child's death is high [39]. Without follow-up, the actual mortality rate from MSbP abuse cannot be ascertained, and most case reports not only do not present follow-up information, but clearly do not even attempt it [39,[59][60][61][62][63].…”

“…This lack of knowledge about common MSbP presentations, such as poisonings, is an important way that healthcare systems contribute to MSbP abuse at the diagnostic stage [42,60,65,135]. Failure of clinicians to recognize salt [135] and insulin poisoning [42,60,65], as well as perpetrator-induced septicemia or polymicrobial bacteremia [82,148], can lead victims to experience more MSbP-abuse-related morbidity and mortality as they suffer from the abuse by the perpetrator, while advancing to later stages of treatment for a fictitious or induced condition, thus suffering abuse from the healthcare system itself.…”

“…A fourth way the healthcare system contributes to MSbP abuse is its failure to act immediately upon suspicion of MSbP abuse [60,149]. In their case study of a child who was repeatedly insulin-poisoned, Loo and Yap appear to not realize that the ingestion of insulin was not accidental [60].…”