Baclofen withdrawal and overdose
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Withdrawal syndrome, and respiratory distress and hypotonia following intrathecal administration: case report A 60-year-old man developed withdrawal syndrome after baclofen withdrawal followed by respiratory distress and hypotonia after baclofen overdose. The man had an intrathecal baclofen pump [Archimedes Implantable Constant-Flow Pump] for spastic tetraparesis [dosage and duration of treatment not stated]. His pump became empty and he developed baclofen withdrawal syndrome with increasing lower limb spasticity and myoclonia. The man was admitted to a neurosurgical ward and the empty pump was refilled with baclofen 60mg. Over the next 2 hours, he developed respiratory distress and hypotonicity. He was admitted to the neurological ICU. Examination revealed BP 75/45 mmHg, HR 80 beats/min, Glasgow Coma Scale score 13 (Y3M5V5) and peripheral oxygen saturation 85% with 15 L/min of oxygen. His Glasgow Coma Scale score decreased to 7 (Y1M4V2). He was intubated and received IV fluids. His BP increased and remained stable. A baclofen overdose was suspected. Only 5mL could be retrieved from the pump, so it was estimated he had received 55mg. CSF fluid (80mL) was aspirated to decrease his baclofen concentration. The CSF baclofen concentration was 2062 µg/mL (normal
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