A 75 years old woman with weight about 50kg has a cardiac and respiration arrest and decreased consciousness level following internal bleeding caused by a car accident. Sonography results showed that one of the kidneys is functional. The patient has a history hypertension and an open-heart surgery. During nine months of hospitalization, tracheostomy and PEG was carried out and Central vein line was placed. During the past six months, the patient has been under home ICU care and received nursing care. Currently, the patient has acute limbs spasms and breathes intentionally without supplementary oxygen through a respiratory track. The saturation oxygen level of the patients is 97-100% and she receives Ritalin (5mg), Clexane injection (40mg), Plavix (75mg), atorvastatin (10mg), normal saline serum (1500cc/24h), sodium chloride (15%- 20cc), potassium chloride (5cc, 15% with the serum), sodium valproate 600mg/24h, captopril (75mg/24h), prazosin (1mg/24h), amlodipine (5mg, in the case of systolic blood pressure >160), and carvedilol 6.25 (in the case of heartbeat >80). Our examination of other vital signs indicated a few fever periods and sputum and urine cultures were positive several times and antibiotics were prescribed based on the culture results. The pupils and corneas react to light, while the patient is not able to follow the light or have a meaningful look. In response to painful stimulation, the patent tries to localize and remove the limp. Because of long-term rest in bed, the patient suffers severe spasm and muscle deformity at the upper and lower limbs. Physiotherapy was prescribed for the patients with bracing and skin traction. To solve the severe spasm of upper and lower limbs the attending physician prescribed baclofen 25mg/12hr and after taking two doses, the patient’s level of consciousness decreased in 24hrs with sleepiness and acute loosen muscles of the upper and lower limbs. The patients did not respond to audio stimulations and the pupils had no reaction to light. There was no change in saturated oxygen level and without oxygen saturation was 96%. The patient did not have fever, systolic blood pressure was in 120-190 range and diastolic blood pressure was in 70-110 range. Cardiac rhythm was sinusoidal without arrhythmia and the test result were read (Creatinine: 1.2, Albumin: 2.9, Blood urea nitrogen: 34, Blood sugar: 160, Na: 139, Hemoglobin: 9.1). The liver enzyme level, thyroid function tests, international normalized ratio, partial thromboplastin time, and prothrombin time were normal.
Because the patient had not recently received any new drug other than baclofen, it was stopped. To check for disorder, a brain scan was prescribed and the results indicated no notable point. Sixty hours after stopping baclofen, sleepiness was resolved and the consciousness level increased. The patient was able to open her eyes and react to sounds. The pupils and corneas also reacted to light, the loosen muscles were resolved, and limbs spasm recurred.