Baclofen overdose

Abstract

A 43-year-old man developed rhabdomyolysis and severe neurological symptoms including coma and toxic encephalopathy secondary to self-induced intoxication following baclofen overdose.The man, with chronic ethyl-addiction, was treated with baclofen for a week. He was admitted for coma (Glasgow coma score: 6) after both major alcoholisation and baclofen [Lioresal] ingestion 1000mg (2 boxes, each containing 50 tablets of 10mg). He was found 36 hours after assumed poisoning time.The man was promptly intubated, sedated with midazolam and sufentanil. He was treated with clonazepam because of clonic movements of the arms. He was then transferred to the ICU. Upon admission, cerebral scanner and lumbar puncture were normal. Rhabdomyolysis was noted. Sedation and analgesia were discontinued but he was still in a restless coma, requiring renewed sedation. Neurological evaluation revealed a slowdown basic pattern with signs of generalised brain damage, as demonstrated by the presence of generalised pseudo-periodic triphasic waves, consistent with a toxic encephalopathy. Baclofen blood level was 880 g/L at 36 hours after assumed poisoning time. Concurrently, forced diuresis was performed using over hydration and furosemide. He recovered consciousness 64 hours after assumed poisoning time, followed by alcohol withdrawal syndrome was noted which was specifically controlled with haloperidol. He confirmed his voluntary baclofen poisoning. The outcome was then successful at day 8 and psychiatric care was organised.Author comment: "We report here the case of a patient with severe neurological symptoms after self-induced intoxication with baclofen." Lanoux T, et al. Baclofen poisoning. Toxicologie Analytique et Clinique 26: 206-207, No. 4, Dec 2014. Available from: URL: http://doi.