The Fly in the Ointment by Dr. Joe Schwarcz

Author:Dr. Joe Schwarcz
Language: eng
Format: epub
ISBN: 9781554903993
Publisher: ECW Press
Published: 2013-07-23T16:00:00+00:00

BAD SCIENCE, BAD JUSTICE

The emergency room physician thought he recognized the symptoms. The three-month-old boy was vomiting, breathing with difficulty, and showing virtually no reflexes. A blood test quickly revealed his blood pH to be 7.0, considerably more acidic than the normal pH of 7.4. The doctor had seen cases like this before; the symptoms smacked of ethylene glycol ­poisoning. Could the child have swallowed some antifreeze? A blood sample was sent to a laboratory and sure enough, it turned up positive for ethylene glycol, the main ingredient in commercial antifreeze.

The doctor ordered that intravenous sodium bicarbonate be quickly administered to neutralize the excess acid, and the boy soon recovered. But something seemed strange to the emergency room staff. The mother could not account for the presence of the ethylene glycol in her baby’s blood. Furthermore, there was a history of social problems in the family. Did she try to poison her child deliberately? Was this a case of Munchausen Syndrome by Proxy, a condition in which a psychologically disturbed parent deliberately harms a child to gain attention? The hospital called in social workers, and they decided that there was sufficient evidence to place the baby with foster parents. The mother was, however, allowed visitation rights.

Eight weeks later, following a visit with his mother during which she carried out an unsupervised feeding, the young boy again began to show the same signs of illness he had previously. By the time the foster parents brought him to emergency, his blood had become so acidic that despite all efforts he could not be saved. Once again, tests by two laboratories confirmed the presence of ethylene glycol. This time, Patricia Stallings of St. Louis, Missouri, was arrested for the murder of her son.

Mrs. Stallings was pregnant when she was arrested and gave birth in prison to a baby boy who was, of course, immediately placed with foster parents. Within a short time, the second son began to exhibit symptoms similar to the ones that had afflicted his brother. Since the mother could not possibly have poisoned this baby, a more thorough medical evaluation was carried out. This time the diagnosis was different. Instead of ethylene glycol poisoning, tests determined that the child suffered from the rare genetic disease methylmalonic acidemia (MMA).

This genetic disease occurs in roughly 1 in 48,000 newborns. Victims lack a properly functioning enzyme that is required to metabolize valine, isoleucine, threonine, and methionine, all amino acids that commonly occur in the diet. Vitamin B12 is a required cofactor for this enzyme, but in the so-called vitamin B12–responsive forms of MMA there is for some reason insufficient cofactor available to the enzyme. As a result, methyl­malonic acid, a breakdown product of the abovementioned amino acids, does not get converted to the next product in the normal metabolic sequence. It is the buildup of methylmalonic acid that acidifies the blood and causes the symptoms of MMA to appear.

Interestingly, these symptoms are very similar to those seen for ethylene glycol poisoning. Ethylene glycol

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