Single-dose baclofen-induced neurotoxicity in a patient with end stage renal disease: case report

An Uncommon Side Effect of Baclofen Withdrawal in End Stage Renal Disease

Baclofen is a commonly prescribed muscle relaxant that functions to reduce spasticity associated with a variety of musculoskeletal and neurological conditions. Patients with decreased renal function, however, are at an increased risk of suffering from baclofen withdrawal symptoms. We discuss the case of a 77-year-old male who presented to the emergency room with altered mental status and was admitted for acute metabolic encephalopathy found to be from abrupt cessation of baclofen. The presence of kidney disease in this patient further increased his susceptibility to the withdrawal symptoms that began after cessation of the normal medication regimen. This case further illustrates the importance of both comprehensive history and a high index of suspicion when it comes to patient presentation of baclofen withdrawal.

Baclofen Toxicity in a Dialysis-Dependent Patient: A Case Report

Baclofen toxicity is a significant concern, particularly in patients with advanced chronic kidney disease. We present a case of a 74-year-old female who developed depressed consciousness after receiving 20 mg of baclofen for back pain control. A presumptive diagnosis of baclofen toxicity was made, and the patient underwent continuous hemodialysis sessions, leading to neurological recovery within two days. This case highlights the risk of baclofen toxicity in dialysis-dependent patients with advanced chronic kidney disease, emphasizing the importance of vigilance and alternative treatment options in this population.

Baclofen (fun drug) and ethanol combined poisoning in humans: A histopathology and morphometry model

BACKGROUND

- This study intends to address the scarcity of data regarding the pathogenesis of Baclofen poisoning in humans, which has seen a recent increase, worldwide, especially amongst the young people. Another reason for the conduction of this study was lack of the substantial data about the histo-pathological findings of lungs, in synergistic toxicity of Baclofen with Ethanol, in-spite of it being very common in humans, and both being respiratory depressant with similar mechanism of action.

PURPOSE

- The authors aimed to understand the pathogenesis of fatal poisonings in humans due to Baclofen in combination with Ethanol via an animal research model. The enhancement of the overall scientific literature by extending research along the lines of the handful studies available in this regard was another adjunct goal of the study.

MATERIAL AND METHODS

Fifteen Wistar rats were divided into control and test group of five and ten subjects respectively. The test group was further divided into two sub-groups of five each, with Baclofen administered to one, and it in conjunction with Ethanol to the other, in lowest dosages adjusted for the humans. Rats in both the groups were euthanized by dislocation of the cervical vertebrae for the histopathology examination.

RESULTS

Capillary and venous plethora, hemorrhages in the inter-alveolar septi, hemorrhages into the alveoli and sludging was seen in the 1st sub-group. The plethora of venules, capillaries and arterioles, with sludging by the WBC (white blood corpuscle) infiltrates was seen in the 2nd sub-group. Desquamation of the ciliated epithelium and edematous thickening of the intra-alveolar septi, along with features suggestive of the peri-vascular edema was seen in the 2nd sub-group. The morphometric analysis of the micro vessels showed a significantly higher value of the arteriolar diameter in the 2nd sub-group, in comparison to 1st, but the venular diameter in the two sub-groups did not differ to any extent.

A Small Dose Can Cause a Major Problem

Baclofen is a presynaptic gamma-aminobutyric acid agonist, which has been used to treat muscle spasms. Due to its low cost and low addiction potential, baclofen has been the muscle relaxant of choice for many years. This drug is metabolized in the kidneys, posing a threat to patients with underlying renal dysfunction, with complications ranging from drug toxicity to death. We present a case of baclofen toxicity in a patient with renal failure on hemodialysis, who presented with signs and symptoms of baclofen overdose after consuming 10 mg of the medication. The highlight of this case is the detailed history taking, verifying all home medications, and thorough physical examination of the patient.

Baclofen-induced neurotoxicity in chronic kidney disease: Is there a safe dose?

Most cases of Baclofen toxicity have been reported in patients with impaired kidney functions, within a few days to weeks after ingestion. We report three cases of Baclofen induced encephalopathy in chronic kidney disease patients; two developed encephalopathy within 6–8 h after ingestion of a single tablet and third on 4^th day of consuming 2.5 mg twice daily dose. All three cases recovered fully following haemodialysis treatment.

Short-Term Use of Baclofen Leading to Delirium in a Patient With End Stage Renal Disease Receiving Hemodialysis

Baclofen, a muscle relaxant is primarily excreted by the kidneys. We present the case of a 60-year-old male who developed acute delirium, visual hallucinations, and behavioral changes after he took a friend’s prescription of baclofen for pain relief. There was immediate improvement after dialysis, and multiple sessions of hemodialysis led to complete resolution of symptoms. A high suspicion for pharmacological causes of delirium is needed in the end stage renal disease (ESRD). Baclofen is known but under recognized cause of acute delirium in ESRD patients. We discuss the pharmacokinetics of baclofen. We suggest reducing dose or preferably avoiding use of baclofen in ESRD patients, especially the elderly.

Removal of baclofen with hemodialysis is negligible compared to intact kidney excretion in a pediatric overdose: a case report

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.