Persistent Hiccups Baclofen CKD Dose Adjustment — ESENeph MCQ

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HardHaemodialysisPersistent Hiccups Baclofen CKD Dose AdjustmentESENeph

A haemodialysis patient is given baclofen for persistent hiccups. Forty-eight hours later he develops somnolence, confusion and multifocal myoclonus without major metabolic disturbance. What is the best management?

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Correct answer: E — Stop baclofen and arrange urgent haemodialysis

Baclofen is predominantly renally eliminated and even small doses can cause profound encephalopathy in advanced kidney failure. It should generally be avoided in dialysis patients. Baclofen must be stopped; severe neurotoxicity warrants urgent haemodialysis because the drug is dialysable. The source item dangerously presented renally adjusted baclofen as routine treatment for hiccups in ESKD. The competing options do not fit the renal phenotype, temporal relationship, treatment threshold or safety constraint described. Management still requires confirmation of current medicines, renal trajectory and relevant contraindications, followed by timely biochemical and clinical reassessment. Escalate urgently if life-threatening electrolyte disturbance, respiratory compromise, shock, neurological deterioration or a dialysis indication develops.

Reference: MHRA and UK Kidney Patient Safety Committee: Dialysis guidance. https://www.gov.uk/government/publications/dialysis-guidance/dialysis-guidance; BNF: Prescribing in renal impairment. https://bnf.nice.org.uk/medicines-guidance/prescribing-in-renal-impairment/