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Year : 2016  |  Volume : 36  |  Issue : 1  |  Page : 28-30

Altered consciousness following head injury in advanced renal failure: Find the culprit

1 Department of Medicine, Division of Nephrology, Tri-Service General Hospital, National Defense Medical Center, Taipei; Department of Medicine, Armed Forces Taoyuan General Hospital, Taoyuan, Taiwan, Republic of China
2 Department of Medicine, Armed Forces Taoyuan General Hospital, Taoyuan, Taiwan, Republic of China

Correspondence Address:
Shih-Hua Lin
Division of Nephrology, Department of Medicine, Tri-Service General Hospital, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
Republic of China
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1011-4564.177175

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Conscious change following head injury needs a scrutiny of the "nontraumatic" cause to avoid inappropriate management and catastrophic complication. We described an 81-year-old diabetic woman with advanced chronic kidney disease (CKD) (estimated glomerular filtration rate: 6 ml/min/1.73 m 2 ) re-presented to Emergency Department with altered mentality and generalized muscular hypotonia 2 days after falling with a head injury. Her initial mentality was alert, and computed tomography of the brain was negative for organic lesions; she has been given oral baclofen 10 mg daily to control her associated spastic back pain. The repeated laboratory and imaging studies were still unrevealing. Her serum baclofen concentration was markedly elevated (1437 ng/ml). With emergent hemodialysis for two sessions, complete elimination of serum baclofen concentration was accompanied by full recovery of her consciousness. Nontraumatic causes, especially drug-induced neurotoxicity, must be kept in mind in traumatic patients with CKD and unexplained neurological feature.

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