Citation

Lee VR, Shively RM, Connolly MK, Hoffman RS, Nogar J. Clin. Toxicol. (Phila) 2021; 59(3): 231-234.

Copyright

(Copyright © 2021, Informa - Taylor and Francis Group)

DOI

10.1080/15563650.2020.1795188

PMID

32734785

Abstract

INTRODUCTION: Severe baclofen toxicity can result in respiratory failure, hemodynamic instability, bradycardia, hypothermia, seizures, coma, and death. While hemodialysis (HD) is well-described in treating acute baclofen toxicity in patients with end-stage kidney disease or acute kidney injury, the utility of HD for patients with normal kidney function is uncertain. Implementing HD to speed recovery after a large acute baclofen ingestion is appealing, considering: (a) potential for prolonged coma and ventilator-associated morbidity, and (b) baclofen's low protein-binding, low molecular-weight, and moderate volume of distribution.
METHODS: We report a 51 kg, 14-year-old girl who presented to the emergency department (ED) with hypotension, obtundation, and status epilepticus after an intentional ingestion of 1200 mg baclofen. Her post-intubation neurologic examination was concerning for coma. A 14-hour post-ingestion baclofen concentration was 882 ng/mL (therapeutic range 80-400 ng/mL). Three urgent-HD sessions were performed to reduce her time on the ventilator.
RESULTS: The total baclofen removed in the first three-hour HD session was 3.05 mg. The total urinary elimination of baclofen 42 mg over 24-hours on day one. She was discharged without neurologic deficits to psychiatry on day-14.
CONCLUSION: In this case, the amount of baclofen recovered during HD is negligible in comparison to the amount cleared by kidney elimination in this patient with normal kidney function.

Language: en

Keywords

Adolescent; baclofen; Baclofen; Drug Overdose; Emergency Service, Hospital; Female; hemodialysis; Humans; Kidney; Overdose; poisoning; Renal Dialysis; sedative-hypnotic; Suicide, Attempted; toxicology