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Bacteraemic pyelonephritis with polypharmacy — SCE Geriatric Medicine MCQ

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HardInfectionBacteraemic pyelonephritis with polypharmacySCE Geriatric Medicine

An 84-year-old with eGFR 12 mL/min develops somnolence, bradypnoea and multifocal myoclonus three days after baclofen 5 mg three times daily is started. CT brain and infection screen are unrevealing. Which action best addresses the cause?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: CStop baclofen and obtain urgent renal advice about haemodialysis

Explanation lettering: C = shown as B · E = shown as C · B = shown as D · D = shown as E

A ignores profound accumulation at doses that appear low by usual adult standards. B targets a different receptor system. C treats a manifestation while leaving the renally retained toxin present. D is unsafe in severe encephalopathy. E is correct: stop baclofen immediately; severe toxicity in advanced renal failure is dialysable and requires urgent renal and airway assessment.

Reference: Baclofen 10 mg tablets SmPC: https://www.medicines.org.uk/emc/product/2594/smpc