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Core EM - Emergency Medicine Podcast

Episode 70.0 – Baclofen Withdrawal

Oct 31, 2016
Dive into the complexities of baclofen withdrawal, a rare but dangerous condition associated with intrathecal pumps. Symptoms can mirror both sepsis and alcohol withdrawal, leading to serious complications like hemodynamic instability and seizures. Traditional oral treatments often prove ineffective, necessitating emergent interventions such as benzodiazepines and propofol. Surgical consultation is often required to correctly address the underlying device issues. This discussion highlights the urgency and intricacies of managing this critical condition.
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INSIGHT

Baclofen Pump Withdrawal Insights

  • Baclofen delivered intrathecally treats spasticity with minimal systemic effects due to direct CSF infusion.
  • Pump malfunctions cause withdrawal symptoms mimicking sepsis and alcohol withdrawal, requiring high suspicion for diagnosis.
ADVICE

Diagnosing Baclofen Withdrawal

  • Identify baclofen withdrawal by suspicion in patients with intrathecal pumps presenting with sepsis-like symptoms.
  • Use imaging like KUB x-ray or CT and pump interrogation to confirm device malfunction.
ADVICE

Treatment of Baclofen Withdrawal

  • Treat baclofen withdrawal initially with supportive care and aggressive cooling for hyperthermia.
  • Escalate benzodiazepines and propofol, and deliver baclofen intrathecally or consult specialists for pump interrogation and surgical repair.
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