Baclofen Toxicity Responsive to Hemodialysis in a Pediatric Patient with Acute Kidney Injury

Abstract

Background?Baclofen (para-chlorophenyl-gamma-aminobutyric acid) is widely used for its therapeutic effect of providing muscle relaxation from the persistent muscle spasms and posturing often related to spinal and central nervous system injuries. However, baclofen is also a potent neuronal depressant which is most evident in cases of toxicity. In severe toxicity, respiratory failure and obtundation may occur. Case-diagnosis/treatment?We present the case of a neurologically devastated 16-year-old on chronic baclofen therapy for bilateral spastic cerebral palsy (Gross Motor Function Classification System level V) who presented with fever, leukocytosis, and hypotension. Initial management with fluid resuscitation and antimicrobials for presumed infection did initially improve the patient's mental status; however, he subsequently became comatose later during the same hospitalization. Comprehensive diagnostic studies and infectious work-up did not reveal an etiology. Upon further examination of history, acute kidney injury from chronic nonsteroidal use and complicated by vancomycin toxicity was suspected to cause acute baclofen toxicity. The patient underwent a single run of hemodialysis with resultant neurologic improvement and later laboratory-confirmed toxic baclofen levels. Conclusion?Clinicians should consider possible acute baclofen toxicity in patients with impaired renal function who present with neurologic depression. Respiratory failure and mechanical ventilation, with its associated intensive care costs and complications, may be avoided with prompt treatment using hemodialysis.

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

“…12 The successful treatment of baclofen toxicity using hemodialysis was reported in a 16-year-old pediatric male patient with acute kidney injury. 6 With normal kidney function, the treatment of baclofen toxicity is usually supportive. 4 In pediatric populations, most reported cases of baclofen-induced encephalopathy are the result of intentional or accidental overdose and are treated with supportive care measures.…”

“…3 Elsewhere, hemodialysis therapy was administered to a pediatric patient with acute kidney injury. 6 The current study describes a baclofen overdose in a 6-year-old boy with normal kidney function who was treated successfully with high-efficiency high-flux hemodialysis.…”