Baclofen
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Drug-induced encephalopathy: 3 case reports In a case series three patients [2 male and 1 female] aged 11–62 years were described, who developed baclofen induced encephalopathy during treatment with baclofen for intractable hiccups. Case 1: An 11-year-old child, who had chronic kidney disease (CKD) secondary to membrano proliferative glomerulonephritis was placed on haemodialysis for a week. He presented to an emergency department with decreased level of consciousness and somnolence. He was receiving amlodipine along with metoprolol. He was also receiving calcium carbonate, calcitriol, pantoprazole and torasemide [Torsemide]. Further investigation revealed tha, he was started on oral baclofen 2.5mg thrice daily for intractable hiccups one day prior to admission. He was admitted to the ICU. His Glasgow Coma Scale was E3V2M4. His plantar reflex was not elicitable and deep tendon jerks were normal. He became nystagmus. His vital signs showed blood pressure 118/72mm Hg and respiratory rate was 21/minute. A CT scan of cranium and EEG were normal. His cumulative dose of baclofen was 7.5mg. On the next day, he developed confusion. Based on overall investigations and findings, a diagnosis of encephalopathy secondary to baclofen was made. The child was started on symptomatic treatment and baclofen was discontinued. He was given a single session of dialysis. Following 36h of admission, an improvement was noted in his condition. After 2 days, he was discharged without residual neurological deficits. Case 2: A 62-year-old man, who had chronic kidney disease (CKD) due to diabetic nephropathy was placed on irregular haemodialysis for 2 months. He presented with accelerated hypertension and was hospitalised. Additionally, he had uraemia and intractable hiccups for three days. Therefore, he was started on oral baclofen 2.5mg twice daily for 2 days. Following 48h, he developed abnormal behaviour. His Glasgow Coma Scale (GCS) was E3V3M4. He had flexor plantar response and normal deep tendon reflexes. Eye examination showed nystagmus. His vital signs showed blood pressure 150/96mm Hg and respiratory rate 19/minute. A CT scan of cranium was normal. He had been receiving amlodipine, metoprolol, clonidine, calcium carbonate, calcitriol, famotidine and torasemide [Torsemide]. Based on overall observations, a diagnosis of encephalopathy secondary to baclofen was made. The man’s treatment with baclofen was discontinued and the dialysis was performed three times. He was fully alert and oriented following 48h and his GCS was 15. Following 4 days, he was discharged without any residual neurological deficit. Case 3: A 44-year-old woman, who had chronic kidney disease due to amyloidosis, was placed on haemodialysis for 12 weeks. She presented to an emergency department with decreased level of consciousness. She was admitted to the ICU. Her Glassgow Coma Scale was E3V2M4. Her plantar reflex was not elicitable and deep tendon jerks were normal. Her vital signs showed blood pressure 142/86mm Hg and respiratory rate 18/min. A CT scan of craniu
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