A pharmacokinetic approach to the diagnosis of pediatric Munchausen by proxy

A case of a child given unprescribed clonazepam used by her mother, resulting in severe toxicity and supratherapeutic serum concentrations, is described. Elimination pharmacokinetics helped establish the initial dose ingested by the child. Rising levels four days after admission, when the initial concentrations were expected to be negligible, coupled with signs of clonazepam toxicity, established repeated administration of the drug to the child. Constant nursing care resulted in rapid disappearance of the toxic signs. The application of simple therapeutic drug monitoring techniques can be helpful in establishing chemical causes of child abuse.