Successful treatment of severe baclofen toxicosis initially refractory to conventional treatment

Fox, Christine; Daly, Meredith L.

doi:10.1002/ccr3.736

Cited by 3 publications

(8 citation statements)

References 25 publications

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“…In an already neurologically impaired patient, gastric decontamination is largely ineffective and possibly dangerous. Once absorption from the gastrointestinal tract has occurred, intravenous lipid therapy has been used with the aim of binding the circulating baclofen (Fox & Daly, 2016 ). The symptomatic treatment of neurological signs includes seizure control and mechanical ventilation to manage the comatose patients (Dias et al., 2011 ; Torre et al., 2008 ).…”

Section: Discussionmentioning

confidence: 99%

“…The use of extracorporeal therapy has already been described as a strategy to actively remove absorbed baclofen and decrease the duration of intoxication in both human and veterinary medicine (Bates et al., 2013 ; Dias et al., 2011 ; Fox & Daly, 2016 ; Khorzad et al., 2012 ; Scott et al., 2007 ; Torre et al., 2008 ; Wismer, 2004 ; Wu et al., 2005 ). Although baclofen pharmacokinetics is not well established in dogs, the low protein binding (31%), low molecular weight (213 Da) and moderate volume of distribution (in humans 2.5 l/kg) suggest that baclofen is a suitable drug for removal by HD (Faigle & Keberle, 1972 ; Scott et al., 2007 ; Wu et al., 2005 ).…”

Section: Discussionmentioning

confidence: 99%

“…The half-life in human is 3.5-8.6 h, whereas in dogs it has not yet been formally established (Scott et al, 2007). Cases of intoxications from accidental ingestion have already been reported in dogs (Fox & Daly, 2016;Hecht & Allenspach, 1998;Scott et al, 2007). Although the lethal dose is unknown, occurrence of clinical signs has been reported at doses as low as 1.3 mg/kg, while severe neurological signs, coma and death have been observed at doses above 8 mg/kg (Wismer, 2004).…”

Section: F I G U R E 1 Serum Baclofen Concentration During and Follow...mentioning

confidence: 99%

Section: F I G U R E 1 Serum Baclofen Concentration During and Follow...mentioning

confidence: 99%

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Hemodialysis as emergency treatment of a severe baclofen intoxication in a 3 kg dog

Gabba

Iannucci

Vigani

2022

Veterinary Medicine & Sci

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Objective To describe the clinical efficacy and drug removal kinetics of hemodialysis (HD) as emergency treatment in a small size dog with severe baclofen intoxication. Case description A 2‐year‐old dog was presented in stupor to the emergency service a few hours after ingestion of up to 25 mg of baclofen. Medical stabilisation was attempted but was unsuccessful in improving the neurological condition and the patient rapidly progressed to coma. A 4‐h session of HD was performed in emergency with near complete resolution of neurological signs and only mild disorientation by the end of the treatment. No adverse side effects occurred during HD. Baclofen concentration was measured serially during the session. Drug extraction ratio, clearance and mass removal by the dialyser were calculated. Dialytic elimination rate constant ( K d ) was seven times higher than the intrinsic elimination rate constant ( K intr ) and the half‐life ( t ½) during HD was nearly nine times shorter than the endogenous one. New or unique information provided This is the first case report providing pharmacokinetic data associated with HD treatment of severe baclofen intoxication in a dog.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: F I G U R E 1 Serum Baclofen Concentration During and Follow...mentioning

confidence: 99%

Section: F I G U R E 1 Serum Baclofen Concentration During and Follow...mentioning

confidence: 99%

See 2 more Smart Citations

Hemodialysis as emergency treatment of a severe baclofen intoxication in a 3 kg dog

Gabba

Iannucci

Vigani

2022

Veterinary Medicine & Sci

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“…Baclofen is first renally excreted, with only a small portion (15%) being metabolized by the liver. Small amounts of baclofen can cross the blood-brain barrier at therapeutic doses; however, significant drug concentrations can accumulate within the cerebrospinal fluid at higher doses, leading to coma and respiratory depression 3 . Baclofen is available in 10 and 20 mg tablets and as a parenteral injection.…”

Section: Introductionmentioning

confidence: 99%

Baclofen Toxicity in Dogs

Arulselvam,

Kamalakannan,

Ramajothi

et al. 2022

Small Anim. Adv.

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Introduction: Baclofen is a centrally-acting skeletal muscle relaxant used to control spasticity and pain in humans. In an overdose situation, the onset of clinical signs, such as vocalization, vomiting, ataxia, disorientation, salivation, coma, weakness, recumbency, and seizures, is usually noticed. Case report: Case 1- A two-month-old female Spitz pup weighing 5 kg was brought to the Small Animal Medicine unit of Veterinary Clinical. Complex (VCC), Rajiv Gandhi Institute of Veterinary Education and Research (RIVER), Puducherry, India, with a history of vomiting, vocalization, and restlessness for the past hour. After recording the history, it was revealed that the dog had accidentally consumed four Baclofen tablets (10 mg each). The animal was immediately treated with fluids, activated charcoal, and Kaolin mixed with water (orally). The gradual reduction in clinical signs was noticed by the lower of 12 hours, and a dramatic improvement was noticed the day after, and the pup recovered completely. Case 2- A six-month-old male Labrador dog weighing 20 kg was brought to the Small Animal Medicine unit of VCC, RIVER, Puducherry, India, with a history of vocalization, restlessness, and salivation for the past two hours. After considering the history, it was revealed that the dog had accidentally ingested eight Baclofen tablets of 10 mg. The animal was immediately treated with fluids (Injection) Atropine sulfate and activated charcoal mixed with water (orally). The gradual reduction of clinical signs was noticed in less than 12 hours, dramatic improvement was noticed the next day, and the dog recovered completely. Conclusion: Timely diagnosis and proper management of the toxicity with drugs can eliminate the clinical signs, and fluid therapy can help the animal’s recovery.

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Lipid emulsion in the management of poisoning

Bates¹

2018

Companion Animal

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Lipid emulsion therapy is the intravenous infusion of a parental lipid formulation, which can be used in the management of some toxic substances, particularly fat-soluble (lipophilic) compounds. Although the mechanism is not fully understood, the lipid is thought to act as a ‘shuttle’, facilitating redistribution of the toxic compound. Adverse effects from the use of lipid emulsion in the management of poisoning appear to be rare. Lipid is straightforward to administer and a relatively inexpensive treatment option, and should be considered in an animal failing to respond to other therapies after exposure to a substance that fits the criteria for lipid emulsion treatment: high lipid solubility, high volume of distribution and short to moderate half-life.

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Successful treatment of severe baclofen toxicosis initially refractory to conventional treatment

Cited by 3 publications

References 25 publications

Hemodialysis as emergency treatment of a severe baclofen intoxication in a 3 kg dog

Hemodialysis as emergency treatment of a severe baclofen intoxication in a 3 kg dog

Baclofen Toxicity in Dogs

Lipid emulsion in the management of poisoning

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