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Intrathecal baclofen overdose and withdrawal.
Kelly W Shirley1, Sanjeev Kothare, Joseph H Piatt
1Department of Emergency Medicine, St Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, PA, USA.
Pediatric Emergency Care
|May 3, 2006
Summary
Intrathecal baclofen (ITB) therapy overdose and withdrawal can be life-threatening. Prompt diagnosis and management are crucial for patients with ITB pumps experiencing toxicity or withdrawal symptoms.
Area of Science:
- Neurology
- Pediatrics
- Emergency Medicine
Background:
- Intrathecal baclofen (ITB) therapy is increasingly used for intractable spasticity in pediatric patients with cerebral palsy and spinal cord injuries.
- Malfunctions in ITB pump systems can lead to severe complications, including baclofen overdose and withdrawal.
Observation:
- A 12-year-old boy on long-term ITB therapy presented with obtundation and respiratory arrest, mimicking head trauma.
- Symptoms progressed to baclofen withdrawal, including hypertension and hallucinations, as overdose symptoms resolved.
Findings:
- The patient's presentation was initially misdiagnosed due to symptoms mimicking other conditions.
- Diagnosis was confirmed by family history of recent pump refill, preceding symptom onset.
- The ITB pump was found disconnected and subsequently revised.
Implications:
- Emergency medicine physicians must be aware of ITB pump mechanics and potential complications.
- Timely recognition and management of baclofen toxicity and withdrawal are critical for patient outcomes.
- Increased use of ITB therapy necessitates enhanced physician education on managing related emergencies.