Case report

A 61 year old woman with end stage renal disease who was receiving haemodialysis was admitted with Staphylococcus epidermidis discitis; vancomycin and narcotic analgesics were started. She had a history of hypertension, diabetes, and calciphylaxis. In her fourth week in hospital, oral baclofen 5 mg three times daily was prescribed for back pain and muscle spasms. Within 12 hours she became disoriented, and by 36 hours had deteriorated to a Glasgow coma score of 8. Her other drugs (hydromorphone 5 mg subcutaneously every four hours, pregabalin 50 mg daily, amitriptyline 10 mg at night, lorazepam 1 mg at night, irbesartan, repaglinide, and vancomycin) had not changed. Blood pressure was 140/75, temperature 37.0ºC, heart rate 70 beats/minute, and oxygen saturation 99% on room air. There were no focal neurological deficits. The remainder of the examination was consistent with known problems. Full blood count, electrolytes, and concentrations of glucose, calcium, phosphorus, and magnesium were similar to her previous values and in …