Baclofen-Induced Coma Reversible by Dialysis in a Patient Affected by Acute Kidney Injury

IF 0.3 Q3 MEDICINE, GENERAL & INTERNAL

Clinical Management Issues Pub Date : 2022-06-09 DOI:10.7175/cmi.v16i1.1518

O. Malle, Tadeja Urbanic Purkart, K. Amrein

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Abstract

Baclofen is commonly used to treat muscular spasticity and other conditions such as pain, alcohol withdrawal, and myoclonus. It is contraindicated in chronic kidney disease. As it is eliminated predominantly by the kidneys, acute kidney injury can lead to acute baclofen overdose with central nervous system affection due to drug accumulation. Currently, there is no consensus about the treatment of baclofen intoxication.A 67-year-old woman was admitted with altered mental status and vomiting. Initially, she was unresponsive/lethargic and kept the intermittent ability of nonverbal communication gradually sliding into a comatose state with apneas. Initial neurologic and radiologic examinations ruled out a structural lesion of the central nervous system. Laboratory data showed acute kidney injury and suspected urinary tract infection with extremely high inflammation parameters. The patient had a history of multiple sclerosis and received daily oral baclofen. Baclofen-induced coma secondary to baclofen overdose caused by renal insufficiency was suspected and renal dialysis started within 24 hours. Cystoscopy and implantation of a ureteric stent were necessary because of obstructive nephropathy. During hemodialysis, the patient’s mental status steadily improved. The patient woke up and was oriented and cooperative. Both clinical and laboratory data were widely normalized within days.Diagnosis of baclofen overdose can be challenging, but adequate supportive therapy, including hemodialysis, should be considered to reduce the length of comatose state and the risk of aspiration pneumonia.

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急性肾损伤患者经透析可逆转巴氯芬致昏迷

巴氯芬通常用于治疗肌肉痉挛和其他疾病，如疼痛、酒精戒断和肌阵挛。慢性肾脏病患者禁用。由于巴氯芬主要由肾脏排出，急性肾损伤可导致急性巴氯芬过量，并因药物积累而影响中枢神经系统。目前，对于巴氯芬中毒的治疗尚无共识。一名67岁妇女因精神状态改变和呕吐而入院。最初，她没有反应/昏昏欲睡，并保持间歇性的非语言交流能力，逐渐滑入昏迷状态，并伴有呼吸暂停。最初的神经学和放射学检查排除了中枢神经系统的结构性病变。实验室数据显示急性肾损伤和疑似尿路感染，炎症参数极高。患者有多发性硬化症病史，每日口服巴氯芬。怀疑巴氯芬过量致肾功能不全继发于巴氯芬昏迷，24小时内开始肾透析。由于梗阻性肾病，膀胱镜检查和输尿管支架植入是必要的。血液透析期间，患者精神状态稳步改善。病人醒了过来，有了方向感和合作精神。临床和实验室数据在几天内得到了广泛的规范化。巴氯芬过量的诊断可能具有挑战性，但应考虑适当的支持治疗，包括血液透析，以减少昏迷状态的长度和吸入性肺炎的风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Management Issues MEDICINE, GENERAL & INTERNAL-

自引率

0.00%

发文量

审稿时长

13 weeks

期刊介绍： Clinical Management Issues is an open access, peer-reviewed journal published by SEEd Medical Publishers (online ISSN = 2283-3137). The aim of the published case reports is to expand medical knowledge, allowing a better explanation of the practical application of a clinical guideline, or including an up-to-date review of medical knowledge in that field, or helping doctors to make better decisions in a “grey area”, or explaining how to manage a disease with an integrated approach between different specialists involved. Clinical Management Issues also publishes unusual case reports (i.e. unusual side effects or adverse interactions involving medications, unexpected or unusual presentations of a disease, etc.), articles on clinical management of a disease, case series, editorials, and brief reports. Acceptance rate of submitted articles is about 90%. Content is subject to peer-review and is editorially independent. This journal provides immediate open access to all of its articles (both HTML and PDF versions). Authors are asked to state any professional and financial situations that might be perceived as causing a conflict of interest with respect to integrity of content. The Declaration of Financial Competing Interests, that should be filled, signed and sent to the Publisher, is downloadable here.