Blood Purification in Toxicology:​Reviewing the Evidence and Providing Recommendations

BACLOFEN

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General Recommendation

• In severe acute baclofen poisoning, we suggest against performing ECTR in addition to providing standard care, but rather support providing standard care alone (weak recommendation, very low quality of evidence).

• In severe toxicity from therapeutic baclofen in kidney impairment, we suggest performing ECTR in addition to providing standard care, rather than providing standard care alone (weak recommendation, very low quality of evidence).

Indications

• In patients presenting with toxicity from therapeutic baclofen in kidney impairment, we suggest performing ECTR in the presence of an associated coma requiring mechanical ventilation (weak recommendation, very low quality of evidence).

Choice of ECTR

• In patients requiring ECTR, we recommend performing intermittent hemodialysis, rather than any other type of ECTR (strong recommendation, very low quality of evidence).

Cessation of ECTR

• In patients requiring ECTR, we recommend stopping ECTR based on clinical improvement (strong recommendation, very low quality of evidence).

Miscellaneous

• The panel judged that it is important, if ECTR is performed, that the patient be admitted and followed closely in an appropriately monitored setting for possible signs of withdrawal, especially in patients on long-term maintenance therapy. 

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