Diferencia entre revisiones de «Baclofen withdrawal»
Sin resumen de edición |
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==Background== | ==Background== | ||
*[[Baclofen]] (Lioresal) is an anti-spasmodic that works on the as a GABA- | *[[Baclofen]] (Lioresal) is an anti-spasmodic that works on the as a GABA-B agonist | ||
*Primarily used in patients with | *Primarily used in patients with [[multiple sclerosis]], [[cerebral palsy]], and spinal cord injuries | ||
*Often administered intrathecally but does | *Often administered intrathecally but does have an oral formulation | ||
*Withdrawal symptoms thought to be caused by decreased GABA activation | *Withdrawal symptoms thought to be caused by decreased GABA activation | ||
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*[[Neuroleptic malignant syndrome]] | *[[Neuroleptic malignant syndrome]] | ||
*[[Malignant hyperthermia]] | *[[Malignant hyperthermia]] | ||
{{Template:Sedative/hypnotic withdrawal types}} | |||
==Evaluation== | ==Evaluation== | ||
*History | *History of baclofen use | ||
*Physical exam | |||
*Examination of the pump | *Examination of the pump | ||
*CPK levels | *CPK levels | ||
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Admit: | Admit: | ||
*Organ failure | *Organ failure | ||
*Status epilepticus | *[[Status epilepticus]] | ||
*Pump malfunction | *Pump malfunction | ||
*Fever | *Fever | ||
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*[[Cerebral palsy]] | *[[Cerebral palsy]] | ||
*[[Baclofen toxicity]] | *[[Baclofen toxicity]] | ||
*[[Baclofen]] | |||
==External Links== | ==External Links== | ||
Revisión actual - 05:36 28 ene 2021
Background
- Baclofen (Lioresal) is an anti-spasmodic that works on the as a GABA-B agonist
- Primarily used in patients with multiple sclerosis, cerebral palsy, and spinal cord injuries
- Often administered intrathecally but does have an oral formulation
- Withdrawal symptoms thought to be caused by decreased GABA activation
Clinical Features
Baclofen withdrawal especially in the case of acute intrathecal pump failure may lead to:
- High fevers
- Confusion, altered mental status
- Muscle stiffness
- Seizures
- Rhabdomyolysis
- Multiple organ system failure
- Death
Differential Diagnosis
- Sepsis
- Meningitis
- Epilepsy
- Autonomic dysreflexia
- Neuroleptic malignant syndrome
- Malignant hyperthermia
Sedative/hypnotic withdrawal
- Toxic alcohols
- Benzodiazepines
- Flunitrazepam (Rohypnol)
- Gamma hydroxybutyrate (GHB)
- Baclofen
- Barbiturates
- Opioids
- Chloral hydrate
Evaluation
- History of baclofen use
- Physical exam
- Examination of the pump
- CPK levels
- Electrolytes
- CBC
- LFTs
- Coagulation studies
Management
- High doses of benzodiazepines are the mainstay of treatment
- High dose oral baclofen has been used but has been less effective
- Intrathecal baclofen bolus can be attempted but overdoses are possible with this method
- Dantrolene and cyproheptadine can also be considered but their efficacy is still unproven in this situation
Disposition
Admit:
- Organ failure
- Status epilepticus
- Pump malfunction
- Fever
- Loss of consciousness