Elsevier

The Journal of Emergency Medicine

Volume 17, Issue 6, November–December 1999, Pages 989-993
The Journal of Emergency Medicine

Selected Topics: Toxicology
Baclofen and ethanol ingestion: a case report

https://doi.org/10.1016/S0736-4679(99)00129-8Get rights and content

Abstract

The number of reported cases of skeletal muscle relaxant ingestion has been increasing in the United States, although fatalities are rare. A 30-year-old women ingested 300 mg of baclofen and ethanol. She was able to ambulate into the Emergency Department (ED) 50 min later, but within 30 min post-arrival had a Glasgow Coma Score of 3. She was treated with supportive care including mechanical ventilation for 36 h. Her neurologic status returned to her previous state. Coma may occur rapidly after baclofen overdose, and the respiratory depression may be exacerbated by the co-ingestion of ethanol. Primary importance in the treatment of such ingestions should be placed on maintenance of an airway and respiratory support.

Introduction

Baclofen [4-amino-3(4-chlorophenyl)-butanoic acid] is a lipid soluble derivative of the neurotransmitter γ-aminobutyric acid (GABA) and appears to act as a pre-synaptic agonist. It is used as a skeletal muscle relaxant for alleviation of symptoms of spasticity associated with various neurologic conditions such as multiple sclerosis and traumatic diseases 1, 2. The drug acts predominantly at the spinal cord level and is rarely associated with severe adverse effects when taken in therapeutic doses. In an overdose, there appears to be prominent central nervous system effects, and the complications are associated with the drug’s neurotransmitter inhibitory action, including respiratory depression, muscle weakness, coma, and seizures 2, 3. We report a case of intentional baclofen overdose with ethanol co-ingestion, the clinical course, treatment, and outcome.

Section snippets

Case report

A 30-year-old woman was brought to the University Hospital Emergency Department (ED) by a friend at 10:30 PM. The friend stated that the patient was depressed about an ongoing evaluation in the neurology clinic for lower extremity weakness, spasms, and tremors that were thought to be due to multiple sclerosis. The woman had been seen in the clinic earlier that day and been prescribed 180 baclofen 10 mg tablets. Approximately 50 min before arrival, the friend’s son had witnessed the patient take

Pharmacology of baclofen

Baclofen is chemically structured as an analog of the naturally occurring neurotransmitter γ-aminobutyric acid (GABA), but because it is more lipophilic, it can readily penetrate the blood-brain barrier (4). The exact mechanism by which baclofen produces its antispasticity effects is unknown, but it is thought to be secondary to the suppression of excitatory neurotransmitter release at certain GABA receptors (5). At the spinal cord level, baclofen has been shown to inhibit both monosynaptic and

Conclusion

We report the case of a patient who presented to the ED after the ingestion of baclofen and ethanol. Her level of consciousness and respiratory efforts deteriorated rapidly. She recovered after supportive care including mechanical ventilation for 36 h. Since coma may occur rapidly after baclofen overdose and the respiratory depression may be exacerbated by the co-ingestion of ethanol, primary importance in the treatment of such ingestions should be placed on maintenance of an airway and

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