Removal of baclofen with hemodialysis is negligible compared to intact kidney excretion in a pediatric overdose: a case report
Publication Date
2020
Journal Title
Clin Toxicol
Abstract
© 2020 Informa UK Limited, trading as Taylor & Francis Group. 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.
Document Type
Article
Status
Faculty
Facility
School of Medicine
Primary Department
Emergency Medicine
PMID
DOI
10.1080/15563650.2020.1795188