Recognizing and Managing Life-threatening Toxicity in Pediatric Baclofen Poisoning: A Case Report

Baclofen is a GABA-β receptor agonist used to treat spasticity, and its rising recreational use has led to increased reports of intoxication. Overdose may cause central nervous system depression, coma, seizures, and respiratory depression. This case report describes a case of accidental baclofen intoxication in a 2-year-old boy with a history of neonatal encephalopathy. A 2-year-old boy presented to the emergency department with sudden-onset drowsiness one hour after his sister suspected accidental ingestion of baclofen syrup (10 mg/mL) prescribed to his bedridden mother. The child was found holding the bottle, which was missing approximately 25% of its contents, suggesting an estimated ingestion of 300 mg, nearly 66 times the maximal daily pediatric dose. Upon arrival at the hospital, three hours post-ingestion, the patient was unresponsive with a Glasgow Coma score of 6, requiring emergency intubation. He was also noted to be bradypneic, bradycardic, hypotensive, and hypothermic with constricted and unreactive pupils, generalized hypotonia, and areflexia. Laboratory tests were largely unremarkable except for hypokalemia. An electrocardiogram showed bradycardia with a prolonged QTc interval. The patient’s treatment was primarily supportive. After 19 hours of ventilation, he showed significant improvement, regained consciousness, and was successfully weaned off ventilation. He was later discharged without neurological sequelae. This case highlights the importance of considering baclofen overdose in pediatric patients presenting with coma, hypotonia, bradypnea, bradycardia, and hypotension, even with normal kidney function. Diagnosing baclofen toxicity can be challenging as it is not routinely detected in urine toxicology screenings. The case emphasizes the need for caregiver education regarding medication safety and proper storage to prevent unintentional poisoning. Although treatment is mainly supportive, this case adds to the growing body of literature on pediatric baclofen toxicity and the potential for good outcomes with timely intervention.