Short-Term Use of Baclofen Leading to Delirium in a Patient With End Stage Renal Disease Receiving Hemodialysis

Suhaib A Andrabi,Sudhanshu Jain,Anya Weerasinghe,Muhammad Faisal Riaz,Maryam Handoo

doi:10.7759/cureus.9778

Abstract

Baclofen, a muscle relaxant is primarily excreted by the kidneys. We present the case of a 60-year-old male who developed acute delirium, visual hallucinations, and behavioral changes after he took a friend’s prescription of baclofen for pain relief. There was immediate improvement after dialysis, and multiple sessions of hemodialysis led to complete resolution of symptoms. A high suspicion for pharmacological causes of delirium is needed in the end stage renal disease (ESRD). Baclofen is known but under recognized cause of acute delirium in ESRD patients. We discuss the pharmacokinetics of baclofen. We suggest reducing dose or preferably avoiding use of baclofen in ESRD patients, especially the elderly.

Highlights

Baclofen is a known but uncommon cause of altered mental status
We present the case of a 60-year-old male who developed acute delirium, visual hallucinations, and behavioral changes after he took a friend’s prescription of baclofen for pain relief
We suggest reducing dose or preferably avoiding use of baclofen in end stage renal disease (ESRD) patients, especially the elderly

Summary

Introduction

Baclofen is a known but uncommon cause of altered mental status It is a gamma aminobutyric acid (GABA) agonist and acts by inhibiting polysynaptic and monosynaptic reflexes at spinal cord [1]. A 60-year-old male was brought in by emergency medical services (EMS) for altered mental status He was in usual state of health prior to being found lying in his bathroom, according to relatives. Chest X-ray (CXR) showed left basilar atelectasis/consolidation with or without pleural effusion (Figure 1) He was admitted to ICU for management of suspected sepsis and meningitis was one of the differential diagnosis. Baclofen level sent after first hemodialysis session was 0.10 mcg/mL (upper limit 0.20 mcg/mL) His antibiotics were stopped as there was no focus of infection and he was not febrile. WBC, white blood cell; Na, sodium; K, potassium; BUN, blood urea nitrogen; Cl, chloride; CO2, bicarbonate; Day 0, predialysis; Day 1, 3, 4, postdialysis

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