Baclofen Toxicity Responsive to Hemodialysis in a Pediatric Patient with Acute Kidney Injury

Background Baclofen (para-chlorophenyl-gamma-aminobutyric acid) is widely used for its therapeutic effect of providing muscle relaxation from the persistent muscle spasms and posturing often related to spinal and central nervous system injuries. However, baclofen is also a potent neuronal depressant which is most evident in cases of toxicity. In severe toxicity, respiratory failure and obtundation may occur. Case-diagnosis/treatment We present the case of a neurologically devastated 16-year-old on chronic baclofen therapy for bilateral spastic cerebral palsy (Gross Motor Function Classification System level V) who presented with fever, leukocytosis, and hypotension. Initial management with fluid resuscitation and antimicrobials for presumed infection did initially improve the patient's mental status; however, he subsequently became comatose later during the same hospitalization. Comprehensive diagnostic studies and infectious work-up did not reveal an etiology. Upon further examination of history, acute kidney injury from chronic nonsteroidal use and complicated by vancomycin toxicity was suspected to cause acute baclofen toxicity. The patient underwent a single run of hemodialysis with resultant neurologic improvement and later laboratory-confirmed toxic baclofen levels. Conclusion Clinicians should consider possible acute baclofen toxicity in patients with impaired renal function who present with neurologic depression. Respiratory failure and mechanical ventilation, with its associated intensive care costs and complications, may be avoided with prompt treatment using hemodialysis.