see: [Austin - Baclofen overdose](x-devonthink-item://D302A057-ACD1-49BE-8CB1-B1414828FA96), [Murray - Baclofen overdose](x-devonthink-item://DA1896AC-D57C-4A67-B2C7-65B1D27BB53E?page=182), [Baclofen - Hayes'](x-devonthink-item://80E982AE-A8C0-43E5-8177-A59C034E5249), [Goldfrank](x-devonthink-item://2F041FBD-FF1C-4E21-9CD5-5550C288F006?page=264) > [!key points] > - Ingestions >200 mg in adults are expected to cause significant CNS effects including delirium, respiratory depression or [[Coma]]. > - Coma requiring intubation can occur with much lower doses, particularly in baclofen-naive patients. > - Accumulation can occur with therapeutic dosing in the setting of renal dysfunction, resulting in significant toxicity. > - May need intubation >72 hours ## Symptoms - [[Coma]] - [[Hypothermia]] - hypotension - [[Bradycardia]] - [[Seizures]] > **Baclofen toxicity may mimic brain death:** > - Fixed [[Mydriasis|dilated pupils]], hypotonia, absent reflexes - Coma may last for days ## Disposition - Observe all patients for at least 4 hours post baclofen ingestion for development of toxicity - Discharge pending mental health assessment if well at 4 hours post ingestion - Patients with minor CNS effects should be observed until all clinical features resolve - Advise patient not to drive for at least 72 hours post exposure