Screening: 12 lead ECG, BSL, Paracetamol level.Once the patient has recovered form the overdose it is important to re-institute the regular baclofen, otherwise a withdrawal state will occur mimicking ongoing toxicity (occurs 24 – 48 hours later with seizures, hallucinations, dyskinesia and visual disturbances).If intubated see FASTHUGSINBED for further supportive care.Children: one 25mg tablet can produce a coma in a 10 kg toddler. Cardiovascular symptoms include sinus bradycardia or tachycardia, hyper- or hypotension, 1st degree heart block and QT prolongation (rare).In large overdoses patients can appear brain dead with fixed dilated pupils, hypotonia, areflexia (including absent brainstem reflexes).The duration of coma can last 24 – 48 hours.Intoxication will develop within 2 hours, delirium is most evident just prior to the onset of coma.>200 mg in adults causes significant CNS depression, delirium, respiratory depression, coma and seizures.Hypotension: Usually responds to fluid bolus and inotropes are rarely required.Can be managed with benzodiazepines (varying doses in the textbooks, easy method is 0.1mg/kg IV for lorazepam (max 4mg) / midazolam (max 10mg) / diazepam (max 10mg).Reduced GCS and respiratory depression: Early intubation and ventilation.15% metabolised by the liver otherwise excreted unchanged in the urine.And like GABAa withdrawal the same situation can occur if a patient suddenly stops baclofen and withdrawal syndromes can manifest. Complicating this baclofen also mediates pre- and postsynaptic inhibition (therefore inhibiting the inhibitor) causing seizures in overdose. At a therapeutic dose it acts on spinal GABAb receptors but in overdose this selectivity is lost and the GABA receptors in the brain are targeted resulting in sedation and coma. The mainstay of treatment is good supportive care.īaclofen is a synthetic derivative of GABA. In large overdose the patient can appear brain dead and it has resulted in the pursuit of organ donation only for the patient to wake on the operating table. Baclofen in overdose produces a rapid onset of delirium, respiratory depression, coma and seizures.
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