Biochemical munchausen’s - a “baffling” case of recurrent hypokalemia and lactic acidosis - secondary to surreptitious salbutamol abuse in a 36-year-old female

Factitious medical disorders with the well-known eponym of Munchausen’s syndrome represent a challenge in both diagnosis and management for the clinician. Here, we report a case of “Biochemical Munchausen’s” in a 36-year-old female, characterised by recurrent and multiple presentations with symptomatic hypokalaemia, supraventricular tachycardia and lactic acidosis that required the use of biochemical laboratory expertise and liquid chromatography/mass spectrophotometry to unravel and break the cycle of costly investigations and hopefully contain the risk of potential harm. We also highlight the evolution of various stages of generating factitious illness in this 36-year-old female with the crucial breakthrough being made only by proof of the biochemical exposure through the close collaboration of biochemist and clinicians.