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

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Abstract

Background

Baclofen is a centrally acting GABA _B receptor agonist and it is used widely for the treatment of spasticity, persistent hiccups and multiple sclerosis. The renal system is the main route of excretion, thus people with suboptimal renal function are prone to baclofen intoxication. Multiple doses of baclofen have been associated with toxicity, but it is very unusual that single dose can do so.

Case presentation

A 47 year old female patient with end stage renal disease (ESRD) presented with a sudden onset of altered mental status and state of unconsciousness after the ingestion of one tablet of baclofen 25 mg. All other possible causes were ruled out and a diagnosis of baclofen toxicity was considered. The patient showed dramatic improvement after an extra two sessions of hemodialysis.

Conclusions

We highly recommend that more educational efforts are made for health care professionals about the possible risk of baclofen toxicity among kidney-impaired patients. We also recommend avoiding baclofen use if evidence of chronic renal disease is present and to seek other alternatives for pain management.

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Most cited references 15

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Posterior reversible encephalopathy syndrome: associated clinical and radiologic findings.

Jennifer E Fugate, Daniel Claassen, Harry Cloft … (2010)

To identify and define clinical associations and radiologic findings of posterior reversible encephalopathy syndrome (PRES). Patients prospectively diagnosed as having PRES from October 1, 2005, through April 30, 2009, were pooled with retrospectively identified patients admitted from August 1, 1999, through September 30, 2005. We performed a detailed review of clinical information, including demographics, presenting symptoms, medical history, and risk factors. All patients underwent computed tomography of the brain or magnetic resonance imaging. Findings on magnetic resonance imaging were analyzed independently by 2 neuroradiologists. We identified 120 cases of PRES in 113 patients (mean age, 48 years). Mean peak systolic blood pressure was 199 mm Hg (minimum-maximum, 160-268 mm Hg), and mean peak diastolic blood pressure was 109 mm Hg (minimum-maximum, 60-144 mm Hg). Etiologies of PRES included hypertension (n=69 [61%]), cytotoxic medications (n=21 [19%]), sepsis (n=8 [7%]), preeclampsia or eclampsia (n=7 [6%]), and multiple organ dysfunction (n=1 [1%]). Autoimmune disease was present in 51 patients (45%). Clinical presentations included seizures (n=84 [74%]), encephalopathy (n=32 [28%]), headache (n=29 [26%]), and visual disturbances (n=23 [20%]). In the 115 cases (109 patients) for which magnetic resonance imaging findings were available, the parieto-occipital regions were the most commonly involved (n=108 [94%]), followed by the frontal lobe (n=88 [77%]), temporal lobe (n=74 [64%]), and cerebellum (n=61 [53%]). Cerebellar involvement was significantly more frequent in patients with a history of autoimmunity (P=.008), and patients with sepsis were more likely to have cortical involvement (P<.001). A substantial proportion of patients with PRES have underlying autoimmune conditions that may support endothelial dysfunction as a pathophysiologic mechanism. On brain imaging, the location and severity of vasogenic edema were mostly similar for the different clinical subgroups.

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Posterior reversible encephalopathy syndrome

Marlene Fischer, Erich Schmutzhard (2017)

The posterior reversible encephalopathy syndrome (PRES) is a neurological disorder of (sub)acute onset characterized by varied neurological symptoms, which may include headache, impaired visual acuity or visual field deficits, disorders of consciousness, confusion, seizures, and focal neurological deficits. In a majority of patients the clinical presentation includes elevated arterial blood pressure up to hypertensive emergencies. Neuroimaging, in particular magnetic resonance imaging, frequently shows a distinctive parieto-occipital pattern with a symmetric distribution of changes reflecting vasogenic edema. PRES frequently develops in the context of cytotoxic medication, (pre)eclampsia, sepsis, renal disease or autoimmune disorders. The treatment is symptomatic and is determined by the underlying condition. The overall prognosis is favorable, since clinical symptoms as well as imaging lesions are reversible in most patients. However, neurological sequelae including long-term epilepsy may persist in individual cases.

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Baclofen overdose: defining the spectrum of toxicity.

Geoffrey Isbister, Nicola Y Leung, Ian M Whyte (2006)

To describe the spectrum of toxicity of baclofen in overdose, and investigate dose-related clinical effects.

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Author and article information

Contributors

Emad Khazneh: emad.khazneh@gmail.com

Alaa Shamlawi: alaashamlawi88@gmail.com

Kamel Jebrin: kjebrael@yahoo.com

Zakaria Hamdan: z.hamdan@najah.edu

Osama Sawalmeh: +970-599-720171 , osamah.2008@yahoo.com

Journal

Journal ID (nlm-ta): BMC Nephrol

Journal ID (iso-abbrev): BMC Nephrol

Title: BMC Nephrology

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2369

Publication date (Electronic): 11 December 2018

Publication date PMC-release: 11 December 2018

Publication date Collection: 2018

Volume: 19

Electronic Location Identifier: 352

Affiliations

[1 ]ISNI 0000 0004 0631 5695, GRID grid.11942.3f, Nephrology Consultant, Nephrology department, , An-Najah National University Hospital, ; Nablus, Palestine

[2 ]ISNI 0000 0004 0631 5695, GRID grid.11942.3f, Internal Medicine resident, Internal Medicine Department, , An-Najah National University Hospital, ; Nablus, Palestine

[3 ]ISNI 0000 0004 0631 5695, GRID grid.11942.3f, Intern Doctor, Internal Medicine Department, , An-Najah National University Hospital, ; Nablus, Palestine

Article

Publisher ID: 1167

DOI: 10.1186/s12882-018-1167-z

PMC ID: 6288861

PubMed ID: 30537935

SO-VID: b7143db2-5adb-4726-8c1c-636059c938d8

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 16 March 2018

Date accepted : 30 November 2018

Custom metadata

ScienceOpen disciplines: Nephrology

Keywords: baclofen,toxicity,neurotoxicity,end stage renal disease,esrd,chronic kidney disease,overdose,case report

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ScienceOpen disciplines: Nephrology

Keywords: baclofen, toxicity, neurotoxicity, end stage renal disease, esrd, chronic kidney disease, overdose, case report

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

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Abstract

Background

Case presentation

Conclusions

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Karger: Nephrology

Most cited references 15

Posterior reversible encephalopathy syndrome: associated clinical and radiologic findings.

Posterior reversible encephalopathy syndrome

Baclofen overdose: defining the spectrum of toxicity.

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