Baclofen Toxicity - The Importance of Medication Reconciliation (2400)

Objective: To describe a case of low-dose baclofen-related encephalopathy in the setting of renal disease, emphasizing the importance of medication reconciliation to avoid adverse events. Background: Baclofen is a gamma-aminobutyric acid (GABA) type-B receptor agonist used for muscle spasticity. Symptoms of baclofen toxicity include confusion, somnolence, nausea/vomiting, myoclonus, hypotonia, coma, seizures, and autonomic dysfunction. Baclofen is primarily renally excreted; renal impairment increases toxicity risk even with modest doses. EEG findings include generalized slowing, burst suppression, triphasic waves, rhythmic high-amplitude delta waves, and non-convulsive status epilepticus. Design/Methods: NA Results: A 27-year-old hemodialysis-dependent African-American female with spina bifida sustained second-degree lower extremity burns. Outpatient medications listed baclofen 10 milligrams three times daily and multiple other medications. On hospital day 2, cefepime, metronidazole, and vancomycin were begun for sepsis. Later that evening, she became progressively nonverbal and encephalopathic with no new focal deficits. Acyclovir was added for possible viral encephalitis and brain MRI was unremarkable. Continuous renal replacement therapy was instituted. On hospital day 4, she was intubated, and EEG showed burst suppression. On day 5, baclofen was discontinued and sedation changed from propofol to dexmedetomidine. By day 6, she followed commands and answered questions; EEG transformed to nearly continuous sharply contoured theta. By day 7, EEG background was 7–8 Hz. She was at baseline mental status by day 8, was extubated, and antimicrobials were discontinued. It was determined then she took baclofen only rarely as needed. Conclusions: Baclofen toxicity can cause adverse events in metabolically vulnerable patients, even at modest doses, and this may not be well known among clinicians. Electronic health record software can query outside pharmacy medication dispense reports which would have identified that this patient rarely took baclofen. This is especially useful for non-verbal patients often seen in neurology consultations. Disclosure: Dr. Smith has nothing to disclose. Dr. Fahy has nothing to disclose. Dr. Cibula has nothing to disclose.