II. Background

  1. Toxic oral doses
    1. Symptomatic at >150 mg ingestion, and serious complications at ingestions of >300 mg

III. Findings

  1. Altered Level of Consciousness (to coma)
  2. Respiratory depression
  3. Hypotonia
  4. Hypotension
  5. Hypothermia
  6. Bradycardia
  7. Seizures (to Status Epilepticus)
    1. Present in both Baclofen Overdose and withdrawal

IV. Differential Diagnosis

  1. Baclofen Withdrawal
    1. Both Baclofen Withdrawal as well as Overdose can cause coma and Status Epilepticus
    2. Benzodiazepines are effective in both conditions
    3. Interrogate Intrathecal Baclofen Pump if present

V. Management

  1. ABC Management
  2. Supportive Care
  3. Seizures
    1. Benzodiazepines (GABA-A active) are most important first-line agents
    2. Consider EEG to evaluate for non-convulsive Status Epilepticus
  4. Other measures
    1. Hemodialysis
      1. May be indicated in End Stage Renal Disease or Acute Kidney Injury
    2. Lumbar Puncture
      1. May be indicated in intrathecal Baclofen Overdose
      2. Withdraw 30 ml CSF
  5. Disposition
    1. Asymptomatic
      1. Observe for 4-6 hours after ingestion and may discharge home if no significant symptoms
    2. Symptomatic
      1. Hospital admission for up to 2-3 days after ingestion if significantly symptomatic

VI. References

  1. Gao and Tomaszewski (2018) Crit Dec Emerg Med 32(9): 28

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