Intrathecal baclofen withdrawal mimicking sepsis.
Baclofen (Lioresal) is a drug of choice to treat spasticity and is increasingly being administered intrathecally via an implantable pump in cases refractory to oral therapy. Emergency physicians will likely treat patients with baclofen withdrawal or overdose as this treatment becomes more widespread. The syndrome of baclofen withdrawal presents with altered mental status, fever, tachycardia, hypertension or hypotension, seizures, and rebound spasticity, and may be fatal if not treated appropriately. Baclofen withdrawal may mimic other diseases including sepsis, meningitis, autonomic dysreflexia, malignant hyperthermia, or neuroleptic malignant syndrome. Treatment consists of supportive care, reinstitution of baclofen, benzodiazepines, and diagnosis and eventual repair of intrathecal pump and catheter malfunction.
Kao
Louise W
LW
Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Amin
Yama
Y
Kirk
Mark A
MA
Turner
Michael S
MS
D001418:Baclofen / Q000009:adverse effects*; D002675:Child, Preschool; D002985:Clinical Protocols; D003655:Decerebrate State / Q000139:chemically induced; D003937:Diagnosis, Differential; D004638:Emergency Treatment / Q000379:methods; D004868:Equipment Failure; D005334:Fever / Q000139:chemically induced; D006801:Humans; D015918:Infusion Pumps, Implantable / Q000009:adverse effects; D007278:Injections, Spinal; D008297:Male; D009125:Muscle Relaxants, Central / Q000009:adverse effects*; D009128:Muscle Spasticity / Q000188:drug therapy; D018458:Persistent Vegetative State / Q000139:chemically induced; D011782:Quadriplegia / Q000188:drug therapy; D012640:Seizures / Q000139:chemically induced; D018805:Sepsis / Q000175:diagnosis*; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D013610:Tachycardia / Q000139:chemically induced
D009125:Muscle Relaxants, Central; D001418:Baclofen