Severe baclofen intoxication managed with hemodialysis: a case report and review of the literature

Baclofen, a γ-aminobutyric acid-B (GABAB) receptor agonist commonly prescribed for muscle spasticity, is eliminated primarily by the kidneys; therefore, toxicity is more likely and more prolonged in patients with renal impairment. Acute baclofen overdose can cause profound central nervous system depression, leading to respiratory failure and coma. Management relies mainly on supportive care, and extracorporeal treatments such as hemodialysis remain controversial. We report the case of a 16-year-old Moroccan female who developed coma and respiratory depression following a suspected baclofen overdose, with an estimated ingestion of 300 mg. She required endotracheal intubation and mechanical ventilation. Due to profound coma with respiratory depression, hemodialysis was initiated in addition to supportive care, despite preserved renal function and the unavailability of baclofen measurements. Neurological recovery occurred gradually over 72 h without apparent long-term complications. This case underscores the importance of recognizing baclofen toxicity and prioritizing supportive care consistent with the Extracorporeal Treatments In Poisoning (EXTRIP) Workgroup recommendations against routine hemodialysis in preserved renal function. Although hemodialysis was instituted due to profound presentation, its efficacy is unproven, and recovery is attributable to spontaneous clearance rather than dialytic effect.