End-Stage Renal Disease Patient on Hemodialysis With Baclofen-Related Neurotoxicity and Pancreatitis.

Abstract

Background: Baclofen is a centrally acting muscle relaxant used orally and intrathecally for the management of spasticity, muscular spasms, and refractory hiccups. Baclofen is predominantly absorbed via the gastrointestinal tract, with over 80% excreted via the kidneys; hence, individuals with end-stage renal disease (ESRD) are at a heightened risk for baclofen toxicity. Baclofen can penetrate the blood-brain barrier, resulting in neurotoxicity. The potential of baclofen to induce acute pancreatitis is inadequately comprehended, with a limited number of instances documented in the medical literature. This report details an uncommon instance of an ESRD patient undergoing hemodialysis who had both baclofen-induced neurotoxicity and pancreatitis.

Case presentation: We present a case of a 55-year-old woman who is known to have ESRD; she is currently on hemodialysis three times a week. After only two baclofen doses (10 mg, 12 h apart), given for chronic cervical pain, the patient developed a profound decrease in her level of consciousness (LOC). The next day, when her LOC had improved after dialysis, she reported nausea, vomiting, and epigastric abdominal pain as well. Her initial laboratory report showed an elevated amylase level. So, the assessment was a baclofen neurotoxicity in an ESRD patient, which was accompanied by mild-moderate pancreatitis after only two doses. Since baclofen is highly dialyzable, she was commenced on daily conventional hemodialysis using a high-flux dialyzer for three consecutive days. She did not require continuous dialysis. Her LOC improved dramatically after the second session, and she returned to her baseline just after the third session. However, she reported headache and hallucinations after. Pancreatitis symptoms improved with supportive measures later.

Conclusion: The case highlights the need for increased awareness among healthcare providers about the potential risks of baclofen use, particularly in patients with ESRD. Even a small dosing can cause neurotoxicity. This is a very rare case of baclofen neurotoxicity accompanied by pancreatitis, who did respond very well to conventional hemodialysis. Patients with decreased renal function should avoid using baclofen, as its accumulation depends on renal excretion capacity.