II. Background
- Toxic oral doses
- Symptomatic at >150 mg ingestion, and serious complications at ingestions of >300 mg
III. Findings
- Altered Level of Consciousness (to coma)
- Respiratory depression
- Hypotonia
- Hypotension
- Hypothermia
- Bradycardia
-
Seizures (to Status Epilepticus)
- Present in both Baclofen Overdose and withdrawal
IV. Differential Diagnosis
-
Baclofen Withdrawal
- Both Baclofen Withdrawal as well as Overdose can cause coma and Status Epilepticus
- Benzodiazepines are effective in both conditions
- Interrogate Intrathecal Baclofen Pump if present
V. Management
- ABC Management
- Supportive Care
-
Seizures
- Benzodiazepines (GABA-A active) are most important first-line agents
- Consider EEG to evaluate for non-convulsive Status Epilepticus
- Other measures
- Hemodialysis
- May be indicated in End Stage Renal Disease or Acute Kidney Injury
- Lumbar Puncture
- May be indicated in intrathecal Baclofen Overdose
- Withdraw 30 ml CSF
- Hemodialysis
- Disposition
- Asymptomatic
- Observe for 4-6 hours after ingestion and may discharge home if no significant symptoms
- Symptomatic
- Hospital admission for up to 2-3 days after ingestion if significantly symptomatic
- Asymptomatic
VI. References
- Gao and Tomaszewski (2018) Crit Dec Emerg Med 32(9): 28