Prolonged unconsciousness in a patient on automated peritoneal dialysis.
A 79-year-old man with end-stage renal disease treated by automated peritoneal dialysis was referred to the emergency department for altered consciousness. The first investigations, including toxicology screening, failed to reveal the precise etiology. The patient was treated for a possible seizure. After the progression of central nervous system depression with bradypnea, the patient was intubated and mechanically ventilated. It appeared later on that he had ingested by mistake one of his wife's medications, baclofen. Baclofen was detected in the blood sampled on admission at a level above the therapeutic range. Baclofen is mainly excreted by the kidney. A short-term administration of low-dose of baclofen is not effectively removed by peritoneal dialysis and may result in prolonged but reversible coma.
Lois
Fernande
F
Department of Intensive Care, Cliniques St-Luc, Université Catholique de Louvain, Brussels, Belgium.
Wallemacq
Pierre
P
de Tourtchaninoff
Marianne
M
Vanbinst
Roger
R
Laterre
Pierre-François
PF
Goffin
Eric
E
Hantson
Philippe
P
D000368:Aged; D000931:Antidotes / Q000627:therapeutic use; D001331:Automation; D001418:Baclofen / Q000378:metabolism / Q000506:poisoning*; D002851:Chromatography, High Pressure Liquid; D003422:Critical Care / Q000379:methods; D004569:Electroencephalography; D004638:Emergency Treatment / Q000379:methods; D005442:Flumazenil / Q000627:therapeutic use; D016231:Fluorescence Polarization Immunoassay; D018755:GABA Agonists / Q000378:metabolism / Q000506:poisoning*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000378:metabolism / Q000628:therapy; D008297:Male; D008508:Medication Errors / Q000009:adverse effects; D008657:Metabolic Clearance Rate; D009125:Muscle Relaxants, Central / Q000378:metabolism / Q000506:poisoning*; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000379:methods; D012121:Respiration, Artificial; D012646:Self Administration / Q000009:adverse effects; D015813:Substance Abuse Detection / Q000379:methods; D014474:Unconsciousness / Q000175:diagnosis / Q000209:etiology / Q000628:therapy
D000931:Antidotes; D018755:GABA Agonists; D009125:Muscle Relaxants, Central; D005442:Flumazenil; D001418:Baclofen