Removal of baclofen with hemodialysis is negligible compared to intact kidney excretion in a pediatric overdose: a case report

Clin Toxicol (Phila). 2021 Mar;59(3):231-234. doi: 10.1080/15563650.2020.1795188. Epub 2020 Jul 31.


Introduction: Severe baclofen toxicity can result in respiratory failure, hemodynamic instability, bradycardia, hypothermia, seizures, coma, and death. While hemodialysis (HD) is well-described in treating acute baclofen toxicity in patients with end-stage kidney disease or acute kidney injury, the utility of HD for patients with normal kidney function is uncertain. Implementing HD to speed recovery after a large acute baclofen ingestion is appealing, considering: (a) potential for prolonged coma and ventilator-associated morbidity, and (b) baclofen's low protein-binding, low molecular-weight, and moderate volume of distribution.

Methods: We report a 51 kg, 14-year-old girl who presented to the emergency department (ED) with hypotension, obtundation, and status epilepticus after an intentional ingestion of 1200 mg baclofen. Her post-intubation neurologic examination was concerning for coma. A 14-hour post-ingestion baclofen concentration was 882 ng/mL (therapeutic range 80-400 ng/mL). Three urgent-HD sessions were performed to reduce her time on the ventilator.

Results: The total baclofen removed in the first three-hour HD session was 3.05 mg. The total urinary elimination of baclofen 42 mg over 24-hours on day one. She was discharged without neurologic deficits to psychiatry on day-14.

Conclusion: In this case, the amount of baclofen recovered during HD is negligible in comparison to the amount cleared by kidney elimination in this patient with normal kidney function.

Keywords: Overdose; baclofen; hemodialysis; poisoning; sedative-hypnotic; toxicology.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Baclofen / blood
  • Baclofen / pharmacokinetics
  • Baclofen / toxicity*
  • Baclofen / urine
  • Drug Overdose / metabolism
  • Drug Overdose / therapy*
  • Emergency Service, Hospital
  • Female
  • Humans
  • Kidney / metabolism
  • Renal Dialysis*
  • Suicide, Attempted


  • Baclofen