Perry H E, Wright R O, Shannon M W, Woolf A D
Department of Pediatrics, University of Cincinnati College of Medicine, Ohio, USA.
Pediatrics. 1998 Jun;101(6):1045-8. doi: 10.1542/peds.101.6.1045.
Baclofen, a lipophilic analog of gamma-aminobutyric acid, is clinically used to control spasticity. We report a mass exposure to baclofen in adolescents seeking intoxication; toxicokinetic data are included.
A group of adolescents became symptomatic after ingesting 3 to 30 20-mg tablets of baclofen during a party at a suburban Boys' Club. Several children were noted to be very lethargic by chaperones, ingestion was suspected, and paramedics were called. Some white tablets were found in a couch at the site of the party. The Massachusetts Poison Control Center was called, and the tablets were identified as baclofen (20 mg). Fourteen patients were taken to local hospitals; 9 required intubation. Eight adolescents were transferred to our institution. In these 8 patients, symptoms were noted within 1 to 2 hours after overdose. The most common clinical findings included coma (7), hypothermia (6), bradycardia (5), hypertension (4), and hyporeflexia (8). Mean length of mechanical ventilation was 40 hours. Three patients had unifocal premature ventricular contractions. Two patients had tonic-clonic seizures. A single dose of activated charcoal was given to all patients. Drugs administered included nifedipine (1), flumazenil (1), naloxone (1), lorazepam (2), and phosphenytion (2). All patients recovered and were discharged home within 5 days of ingestion. Serial serum baclofen levels were obtained in all intubated patients (range, 0.049 to 6.0; normal, 0.08 to .40 microgram/mL). Levels obtained 14 hours after ingestion showed a linear correlation with length of mechanical ventilation (R2 = 0.9863). Persistent symptoms were noted in some patients, despite nondetectable baclofen levels. Toxicologic screening for drugs of abuse was negative except in 2 patients with ethanol levels, both < 5 mg/dL.
Baclofen overdose may result in coma, apnea, autonomic disturbances, cardiac conduction abnormalities, and seizures. Levels obtained shortly after overdose correlate with length of mechanical ventilation.
巴氯芬是γ-氨基丁酸的亲脂性类似物，临床上用于控制痉挛。我们报告了一群青少年为寻求中毒而大量接触巴氯芬的情况，并纳入了毒代动力学数据。
一群青少年在郊区男孩俱乐部的一次聚会上，服用了3至30片20毫克的巴氯芬片后出现症状。监护人注意到几个孩子非常嗜睡，怀疑有服药情况，于是呼叫了护理人员。在聚会地点的一张沙发上发现了一些白色药片。拨打了马萨诸塞州中毒控制中心的电话，这些药片被确认为巴氯芬（20毫克）。14名患者被送往当地医院；9名患者需要插管。8名青少年被转至我们机构。在这8名患者中，过量服药后1至2小时内出现症状。最常见的临床症状包括昏迷（7例）、体温过低（6例）、心动过缓（5例）、高血压（4例）和反射减退（8例）。机械通气的平均时长为40小时。3例患者出现单灶性室性早搏。2例患者出现强直阵挛性癫痫发作。所有患者均给予了单剂量活性炭。使用的药物包括硝苯地平（1例）、氟马西尼（1例）、纳洛酮（1例）、劳拉西泮（2例）和苯妥英（2例）。所有患者均康复，并在服药后5天内出院。对所有插管患者均进行了连续血清巴氯芬水平检测（范围为0.049至6.0；正常范围为0.08至0.40微克/毫升）。服药后14小时测得的水平与机械通气时长呈线性相关（R2 = 0.9863）。尽管巴氯芬水平检测不到，但一些患者仍有持续症状。除2例乙醇水平低于5毫克/分升的患者外，药物滥用的毒理学筛查结果均为阴性。
巴氯芬过量可能导致昏迷、呼吸暂停、自主神经功能紊乱、心脏传导异常和癫痫发作。过量服药后不久测得的水平与机械通气时长相关。
