A Case Report of Baclofen Toxicity in a Pediatric Patient With Normal Kidney Function Successfully Treated With Hemodialysis

Abstract

Rationale: Baclofen is a commonly prescribed medication used to decrease spasticity in children with cerebral palsy. Despite its widespread use, this medication has not demonstrated to be consistently effective in clinical studies. Baclofen is also associated with systemic adverse effects due to potent neuronal depression. The management of baclofen toxicity is mainly supportive; however, some studies have shown that hemodialysis may alleviate the symptoms of an overdose and shorten the recovery time. Presenting concerns: In this case report, a 6-year-old boy with mild cerebral palsy, neuromyelitis optica, and normal kidney function was found unresponsive at home, with altered mental status, after ingesting 1300 mg of baclofen unobserved. The patient was intubated and mechanically ventilated because of significant neurologic depression with subsequent respiratory failure. Diagnosis: The patient was diagnosed with baclofen-induced encephalopathy. An elevated serum baclofen level of 4.00 µg/mL (therapeutic range of 0.08-0.40 µg/mL) was observed 10 hours after he was found unresponsive. The patient’s respiratory status deteriorated; he had high ventilatory requirements and remained comatose. Intervention: With the worsening of his clinical condition in the intensive care unit, hemodialysis, administered via a high-efficiency high-flux dialyzer, was initiated approximately 18 hours after he was found unresponsive. The patient underwent 2 hemodialysis runs spaced 9 hours apart, with blood flow rates approaching 250 mL/min. Outcomes: Within 3 hours of the first hemodialysis treatment, the patient started to regain consciousness. He was extubated to room air 6 hours after the second hemodialysis treatment. Novel findings: Supportive management is the primary treatment of baclofen toxicity in a pediatric patient with normal kidney function. Hemodialysis may be considered in severe cases of baclofen toxicity and worsening clinical status, but further studies are needed to confirm this finding.

Baclofen overdose: A curious case of medical sales representative

“…Previous literature has suggested that most baclofen overdose patients recover on supportive management and only a few require hemodialysis, especially those with renal impairment. 11 , 16 , 17 A case report shows a dose of baclofen as low as 10 mg can cause toxicity in patient with renal impairment. In such cases, immediate hemodialysis is the key.…”

“…Several cases have been reported where baclofen overdose has mimicked brain death in adult as well as pediatric patients. 2,10,11 Few cases have presented with unusual presentations such as catatonia and psychosis 12 and anoxic encephalopathy. 13 Baclofen overdose is associated with EEG changes as reported in some previous case studies.…”

“…However, baclofen overdose, especially at higher doses, is potentially fatal. Several cases have been reported where baclofen overdose has mimicked brain death in adult as well as pediatric patients 2,10,11 . Few cases have presented with unusual presentations such as catatonia and psychosis 12 and anoxic encephalopathy 13 …”

Fatal multiorgan failure in baclofen overdose: An autopsy case report

“…Oral ingestion results in rapid, complete absorption and is predominantly (> 70%) excreted via kidneys. 3,4 The daily therapeutic dose is predicted to be between five and sixty mg 1 with the therapeutic range ~80 to 400 ng/ml. 4 In the present case, he consumed 15 tablets, which lead to a concentration of 375 mg, more than six times above the maximum allowed therapeutic dose.…”

“…1,2 It crosses the blood-brain barrier due to its moderate lipophilic nature and causes neurotoxicity and resulting in significant CNS depression. 3,4 It results in a wide range of side effects such as weakness, hypotonia, drowsiness, dizziness respiratory failure, altered consciousness (Encephalopathy), seizures, and coma. 2 Although many reports in the published medical literature describe the clinical manifestations and the management of baclofen toxicity, only a few reports presented the fatality in baclofen overdose.…”