title: Baclofen Toxicity in a Patient with Hemodialysis-Dependent End-Stage Renal Disease.
abstract: BACKGROUND
  Oral baclofen toxicity is extremely rare, but can affect patients with renal disease due to the drug's predominant renal clearance of approximately 69-85%. Patients with severely impaired renal function typically develop symptoms soon after initiating baclofen therapy, even at relatively low doses.
  
  
  METHODS
  A 69-year-old woman with a history of hemodialysis-dependent end-stage renal disease presented to the Emergency Department with encephalopathy, ataxia, and dystonia after the addition of a recent baclofen prescription for back pain (10 mg twice daily). She had been taking baclofen as prescribed for approximately 1 week when, the day prior to admission, she had increased her dose to a total of 40 mg. Diagnostic studies demonstrated the patient had chronic, end-stage renal disease and a supratherapeutic concentration of baclofen. Signs and symptoms resolved with hemodialysis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: It is of critical importance for emergency physicians to appreciate impaired baclofen clearance in those with underlying renal disease to obviate the potential for significant drug toxicity.
authors: Department of Emergency Medicine, Lehigh Valley Hospital and Health Network, Allentown, Pennsylvania.
authors: Lauren M
authors: LM
authors: Porter
authors: Department of Emergency Medicine, Lehigh Valley Hospital and Health Network, Allentown, Pennsylvania.
authors: Stephanie S
authors: SS
authors: Merrick
authors: Department of Emergency Medicine, Lehigh Valley Hospital and Health Network, Allentown, Pennsylvania.
authors: Kenneth D
authors: KD
authors: Katz
mesh_terms: D000368:Aged; D001259:Ataxia / Q000209:etiology; D001416:Back Pain / Q000188:drug therapy; D001418:Baclofen / Q000627:therapeutic use / Q000633:toxicity*; D001927:Brain Diseases / Q000209:etiology; D003221:Confusion / Q000209:etiology; D004421:Dystonia / Q000209:etiology; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D058788:GABA-B Receptor Antagonists / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy*; D009127:Muscle Rigidity / Q000209:etiology; D010276:Parasympatholytics / Q000494:pharmacology / Q000627:therapeutic use; D006435:Renal Dialysis / Q000379:methods
chemical_list: D058788:GABA-B Receptor Antagonists; D010276:Parasympatholytics; D001418:Baclofen
keywords: baclofen; end-stage renal disease; hemodialysis; impaired baclofen clearance; toxicity