SHM Converge Scientific Abstract ePoster Gallery-The Pump's Price: Life-Threatening Consequences of Interrupted Intrathecal Therapy

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This case report describes a 54-year-old man with chronic spastic quadriplegia, autonomic dysfunction, tracheostomy, tube feeding, and an intrathecal baclofen pump who developed acute hypertension, fever, tachycardia, and worsening spasticity shortly after discharge from the ICU. Because these findings were severe and not explained by standard blood pressure treatment, clinicians suspected baclofen withdrawal syndrome (BWS), a potentially life-threatening condition that can cause marked autonomic instability.<br /><br />Review of the medical record revealed that he had missed his scheduled baclofen pump refill because of a recent ICU admission. Neurosurgery was consulted, and treatment was started with oral baclofen, cyproheptadine, and diazepam, followed by baclofen pump refill. His course was then complicated by sepsis, bacteremia, ventilator-associated pneumonia, ischemic colitis, and need for vasopressor support in the ICU. After a prolonged decline, the family chose comfort care, and the patient died in the hospital.<br /><br />The case emphasizes several important lessons: BWS is a “can’t miss” diagnosis, especially in patients with implanted baclofen pumps, because abrupt withdrawal can quickly become fatal. Symptoms may include hyperthermia, tachycardia, hypertension, and increased spasticity, and may be resistant to usual antihypertensive therapy. Patients with baseline neurologic impairment may have symptoms that are easy to miss or misattribute.<br /><br />The report also highlights the importance of meticulous medication reconciliation at every transition of care, particularly for device-dependent therapies. Nonverbal or medically complex patients require extra vigilance, and redundant communication and documentation systems may help prevent missed refills and other serious adverse events.

Asset Subtitle

Jacqueline Lippert

Meta Tag

Author List Adrianna L. Elashker, Jacqueline Lippert, Jonathan Doyle, Marc H. Perlman

Category Clinical Vignettes

Concept Baclofen Withdrawal

Concept Intrathecal Baclofen Pump

Concept Autonomic Instability

Concept Hyperthermia

Concept Spasticity

Distinguished Non-Finalist

Presenter Organization Atrium Health Wake Forest Baptist

Presenting Author Jacqueline Lippert

Track Adult

Keywords

baclofen withdrawal syndrome

intrathecal baclofen pump

spastic quadriplegia

autonomic dysfunction

hypertension

fever

tachycardia

spasticity

medication reconciliation

critical care

Baclofen Withdrawal

Intrathecal Baclofen Pump

Autonomic Instability

Hyperthermia

Spasticity