Extreme hyperkalemia in Munchausen-by-proxy syndrome [7]

To the Editor: A 20-month-old girl was admitted to the hospital because of a reported febrile convulsion. Her medical history included recurrent simple febrile convulsions and unexplained slight gynecomastia. Physical examination revealed a well-nourished and cheerful child, with normal vital signs and physical and psychomotor development, except for the slight gynecomastia. Repeated blood tests from different puncture sites sent in different test tubes to the hospital laboratory revealed extreme hyperkalemia, incompatible with life, and very high serum creatinine concentrations (Table 1, samples 1 through 3). The electrocardiogram showed no signs of hyperkalemia. Urine output was normal. The discrepancy between the . . .