Dr. Aicha Telmoudi, Dr. Rahma Guessmi and Dr. Zohra Sassi Jallali
Introduction: Baclofen is a structural analogue of Gamma-Aminobutyric Acid (GABA), which is the main inhibitory neurotransmitter of the central nervous system responsible for muscle relaxation. It is prescribed mainly in the symptomatic treatment of spastic contractures of cerebral origin and muscle spasticity occurring in spinal cord diseases. Baclofen toxicity has been described in the literature. The dose responsible varies according to the studies. Renal failure is a risk factor for the occurrence of baclofen toxicity. Materials and methods: Our case is an adult with chronic renal failure with a renal clearance of 16.5 ml/min who had accidental baclofen intoxication due to the mistaken taking of an inadequate dose of 60 g/day. Results: Mr. F.M., 52 years old, with a history of neurological bladder and chronic renal failure caused by chronic interstitial nephritis with renal clearance of 16 ml/min. The patient consulted with neurological disorders consisting of agitation, hallucinations and incoherent speech in context of apyrexia with the notion of a generalized tonic clonic seizure at home. Blood pressure was 112/70 mm Hg, pulse 79/min, temperature 37.1Â ? and arterial oxygen saturation on ambient air at 98%. There was no focal neurological deficit. Biological investigations showed: Blood glucose at 1 g/l, natremia at 135 mmol/l, HCO3 at 23 mmol/l, calcemia at 2.3 mmol/l, blood urea at 16 mmol/l, renal clearance at 16.5 ml/min and liver function tests (including transaminases, albumin, bilirubin and serum ammonia) were normal. The brain scan returned without anomalies. The resumption of the questioning allowed the diagnosis of baclofen toxicity, recently prescribed, to be retained, due to the mistaken taking of a dose of 60 mg instead of 15 mg per day for seven days. The patient benefited from four daily and prolonged hemodialysis sessions with progressive improvement until the neurological signs disappeared. The time for complete disappearance of the neurological signs of baclofen toxicity is seven days. Discussion: Baclofen is a gamma amino butyric acid receptor agonist of the nervous system prescribed for the treatment of neurological muscle spasticity. The clinical signs of toxicity are mainly due to depression of the central nervous system. It is eliminated mainly by the kidney, hence the importance of monitoring renal function. Severe forms of toxicity may involve acute renal failure, respiratory depression or a comatose state. Treatment is symptomatic in the absence of a specific antidote. Renal failure justifies hemodialysis. A comatose state requires hospitalization in intensive care and mechanical ventilation.
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