Abstract: PO2034
Snow White and the Apple: When Drugs Become Poisons
Session Information
- Clinical Pharmacology, Pharmacokinetics, and Drug Toxicity in Kidney Diseases
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)
- 1800 Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)
Authors
- Agha, Irfan, Medical City Dallas Hospital, Dallas, Texas, United States
- Khan, Naseer, Medical City Dallas Hospital, Dallas, Texas, United States
- Proctor, Gregory W., Medical City Dallas Hospital, Dallas, Texas, United States
- Cespedes, Paul L., Medical City Dallas Hospital, Dallas, Texas, United States
- Nadella, Rama, Medical City Dallas Hospital, Dallas, Texas, United States
Introduction
Commonly used drugs can cause significant toxicity in unfavorable clinical scenarios.
We present a case of a pregnant female on a high dose of baclofen which led to significant neurotoxicity as her GFR dropped during an episode of acute pancreatitis
Case Description
A 29-year-old pregnant Caucasian Female presented to an OSH with abdominal pain of a day's duration.
She was obese and had DM-II, hypertension as well as H/O a brain tumor treated when she was 10 years old. She was 29 weeks pregnant.
Abdominal pain was sharp, epigastric and radiating to her back with nausea and vomiting. She was found to have severe acute pancreatitis.
Her kidney function was normal (creatinine 0.5 mg/dl) on admission but on hospital day 2 it rose to 1.5 mg/dl and was at 2.3 mg/dl the next day. On hospital day #2 she became obtunded without response to naloxone and flumazenil. She was transferred to our hospital.
She was comatose with minimal movement on sternal rub. Her neck was supple without obvious cranial nerve lesions.
MRI of the brain revealed prior (L) frontal craniotomy, post-surgical gliosis and encephalomalacia, stigmata of her brain surgery. EEG suggested encephalopathy but no active seizures.
A review of medicines at OSH revealed baclofen 20 mg TID scheduled for neck muscle spasms.
Neurotoxicity due to baclofen was suspected and urgent CVVH was instituted. By 12 hours, she started improving and by 48 hours, recovered completely. Her AKI as well as pancreatitis resolved.
She eventually delivered a healthy baby girl. Mother and baby were discharged in stable condition.
Baclofen level drawn prior to initiation of therapy was reported at 862 ng/ml.
Discussion
This is a unique case of baclofen neurotoxicity in a pregnant female.
She was prescribed a relatively high dose of baclofen which she was taking sporadically. On admission, she was placed on this standing dose and at the same time lost GFR due to acute pancreatitis. This precipitated neurotoxicity.
She was urgently dialyzed, and the patient and baby were spared neurotoxic sequelae. Prolonged dialysis may be required to remove baclofen and treat neurotoxic manifestations.
This was all the more important in the case due to risk of fetal neurotoxicity
It was a careful review of records of medicines dispensed at the OSH that helped clinch the diagnosis clinically, subsequently confirmed with elevated baclofen levels demonstrated on a send out test.