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Baclofen is a presynaptic GABA-B receptor agonist in the spinal cord that is primarily used for muscle spasms/spasticity. In large overdose, baclofen can produce CNS depression, respiratory depression, bradycardia/hypotension, hypothermia, seizure and coma.
Baclofen is primarily eliminated by the kidney. In patients with end-stage kidney disease/acute kidney failure, hemodialysis (HD) has been used to enhance baclofen clearance. However, it is unclear if there is a benefit of using HD in patients with normal kidney function.
In a recently published case report, HD was implemented in an attempt to shorten the anticipated prolonged ICU course.
Case: 14 year old (51 kg) woman ingested 60 tablets of baclofen (20 mg tablets)
Her symptoms were:
- Coma/CNS depression
- Tonic-clonic seizure
- Transient hypotension (95/47 mmHg – resolved with IV fluids)
- Flaccid extremities
- Initially intubated for airway protection --> no spontaneous breathing on mech. ventilation.
Baclofen level: 882 ng/mL (therapeutic range: 80 – 400 ng/mL)
Baclofen clearance from hemodialysis vs. urine
- 24 hour urine output: 2810 mL --> total baclofen urinary elimination: 42 mg
- 3 hours of HD #1: 3.05 mg removed. Total of 3 HD session performed.
Patient’s mental status improved on hospital day 6 and was extubated. She was discharged to psychiatry on hospital day 14.
Conclusion:
- Although this is a single case report, it appears that hemodialysis does not remove baclofen effectively.
References
Lee VR et al. Removal of baclofen with hemodialysis is negligible compared to intact kidney excretion in a pediatric overdose: a case report. Clin Toxicol. 2020
https://doi.org/10.1080/15563650.2020.1795188