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Neurological Rehabilitation

(Kiosk 3) Baclofen Overdose in Setting of Chronic Kidney Disease: A Case Report

Thursday, November 16, 2023
5:00 PM – 7:00 PM CT

    Primary Author(s)

  • Haris Arshad, DO

    Resident Physician
    Marianjoy Rehabilitation Hospital PM&R Program
    Oak Park, Illinois

    • Co-Author(s)

  • MS

    Melanie A. Stearns, MD

    Attending Physician
    Marianjoy Rehabilitation Hospital
    Wheaton, Illinois

  • Prayag R. Patel, DO

    Resident Physician
    Marianjoy Rehabilitation Hospital PM&R Program
    Oak Park, Illinois

  • Angela Jacob, MD

    Resident Physician
    Marianjoy Rehabilitation Hospital PM&R Program
    Wheaton, Illinois

Case Diagnosis: A 60-year-old male with history of nonalcoholic steatohepatitis (NASH) cirrhosis status post liver transplant, chronic kidney disease (CKD), and recent spinal cord injury with spasticity presented with baclofen toxicity.

Case Description or Program Description: Patient presented to the hospital due to unresponsiveness with increased spastic movements of right lower extremities. A comprehensive neurological work-up was largely unremarkable with the exception of mild elevation of tacrolimus level above goal. The encephalopathy was thought to be due to baclofen overdose in the setting of CKD and ultimately baclofen was discontinued.

Setting: Acute Care Hospital

Assessment/Results: After discontinuation of baclofen, patient subsequently developed tremulousness and visual hallucinations. Psychiatry was consulted and started quetiapine with resolution of symptoms. Once this patient’s condition was stabilized, he was switched to tizanidine for management of his spasticity.

Discussion (relevance): Baclofen acts as an agonist of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) and is very helpful in treating muscle spasticity, especially in patients with spinal cord injuries. Baclofen toxicity can present as depression of the central nervous system with physical exam findings including hypotonia and flaccid paralysis. Impaired kidney function can increase risk for baclofen toxicity as it is renally eliminated. Treatment of baclofen toxicity is discontinuation of baclofen and supportive measures. However, in an attempt to prevent withdrawal, baclofen may be resumed at therapeutic doses once condition has stabilized. In this case, the patient developed subsequent tremors and hallucinations, possibly as a result of baclofen withdrawal.

Conclusions: Baclofen is one of many therapeutic measures to manage spasticity in a patient with a spinal cord injury. It is important to be aware of the adverse effects of baclofen and also the patient’s medical history. In this case, the patient was more susceptible to baclofen overdose due to history of chronic kidney disease. It is also important to monitor for signs of baclofen withdrawal after discontinuation of baclofen.