Baclofen Toxicity in Children With Acute Kidney Injury: Case Reports and Review of the Literature

Child Neurology Open, 2020 · DOI: 10.1177/2329048X20937113 · Published: May 27, 2020

Simple Explanation

Baclofen is a medicine that helps manage muscle tone, especially in conditions like cerebral palsy. It mainly works on the spinal cord, but higher doses can affect the brain. Because it's removed from the body by the kidneys, problems can arise if the kidneys aren't working well. This report describes two young patients with acute kidney injury (AKI) who experienced bad side effects when they started taking baclofen. The drug was given to help with muscle stiffness after their kidney problems began to improve. After starting baclofen, both children had reduced awareness and trouble breathing, requiring them to stop the medicine. This highlights the importance of using lower starting doses, slowly increasing the dose, and carefully watching children with AKI who are starting baclofen.

Study Duration

Not specified

Participants

2 children with acute kidney injury (AKI)

Evidence Level

Case Reports

Key Findings

1
Two children with AKI developed decreased level of consciousness and respiratory difficulties after starting oral baclofen for tone management.
2
Patient 1 developed periodic breathing, bradypnea, bradycardia, and decreased level of consciousness after the second dose of baclofen; these symptoms resolved after discontinuation.
3
Patient 2 developed generalized decreased tone with upper airway obstruction, increased work of breathing, and decreased LOC after receiving 8 doses of baclofen; these symptoms resolved after discontinuation.

Research Summary

The authors described 2 children treated with baclofen for hypertonia, who developed serious side effects due to their compromised kidney function. Both patients presented with severe AKI requiring renal replacement therapy and had respiratory and CNS depression after the initiation of baclofen. The authors suggest caution when initiating baclofen treatment in children with renal impairment, using a reduced initial dose and slowly titrating while monitoring for systemic side effects.

Practical Implications

Dose Adjustment in AKI

Reduced initial baclofen dose and slow titration are necessary for children with AKI.

Monitoring

Close monitoring for systemic side effects is crucial when initiating baclofen in children with AKI.

Clinical Setting

Consider close monitoring in an appropriate healthcare setting.

Study Limitations

1
Small sample size (two case reports).
2
Lack of pharmacokinetic data in children with AKI.
3
Algorithms for dose modification were created for patients with CKD and can differ from patients with acute kidney injury

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