Baclofen overdose
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Various toxicities: case report A 6-year-old boy developed encephalopathy, respiratory failure, generalised tonic-clonic seizure, neurological depression, comatose state and drug toxicity following an accidental overdose of baclofen [time to reactions onset not stated]. The boy presented to an emergency department with altered mental status following ingestion of baclofen 1300 mg (59 mg/kg). On admission day, he had reasonable state of health until the afternoon when his mother found him unresponsive. After reviewing his medications, the bottle which contained 130 tablets (10mg each) of baclofen was empty, which indicated he had ingested baclofen mistakenly. His history was significant for cerebral palsy, spasticity and neuromyelitis optica. His treatment consisted of baclofen (15 mg/day) for treatment of spasticity along with oxcarbazepine, sertraline and gabapentin. His mother reported he had normal cognition, moderate motor delay and mild language delay, although he was able to walk with the help of walker. At current presentation, his temperature was 36°C, BP was 81/44mm Hg, pulse was 94bpm, oxygen saturation was 84% (on room air) and respiration rate was 12bpm. He was unresponsive and he required emergency intubation. He also experienced a brief generalised tonic-clonic seizure, and developed neurological depression. His blood count was normal and his serum and urine drug screen were negative. He was then transferred to the paediatric ICU, where his Glasgow coma scale (GCS) score was 3T. He was mechanically intubated with a pupil diameter of 3mm. A CT scan of the head showed mild sinus disease. Kidney function test showed serum creatinine of 0.2 mg/dL, blood urea nitrogen of 10 mg/dL and urine output ≥2 mL/kg/h (which remained same throughout the hospital stay). Ten hours after he was found unresponsive, the serum baclofen level was 4.00 µg/mL, which was toxic (therapeutic range of 0.08 µg/mL–0.40 µg/mL). A few hours following admission to the ICU, his clinical status worsened. He remained in the comatose state (GCS score of 2T) with increased need for ventillation. Thus, a diagnosis of acute encephalopathy following baclofen toxicity was made. Considering an overdose of baclofen and worsening of clinical condition, the boy was started on haemodialysis for clearance of baclofen. Due to low molecular weight of baclofen, a high-efficiency dialyser having a larger membrane surface area was used. His first haemodialysis lasted for 240 minutes and the second haemodialysis was started 9 hours after the first one. The second haemodialysis lasted for 150 minutes. His BP remained stable with no requirement of additional pressor. His serum phosphorus was monitored every hour with multiple phosphorus replacement. Following his first haemodialysis, he started to regain consciousness. Within 3 hours of first haemodialysis, need for ventilator decreased. Six hours after the second haemodialysis, he completely regained consciousness and he was extubated. Thereafter, he was transferred to the medical ward. His clinical
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