{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T14:57:39Z","timestamp":1753887459001,"version":"3.41.2"},"reference-count":16,"publisher":"American Academy of Pediatrics (AAP)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,8,1]]},"abstract":"<jats:p>Intrathecal baclofen pumps are commonly used in pediatric patients with spastic cerebral palsy. Baclofen binds to \u03b3-aminobutyric acid receptors to inhibit both monosynaptic and polysynaptic reflexes at the spinal cord level. The blockade stops the release of excitatory transmitters and thereby decreases muscle contraction. It is commonly used for lower limb spasticity and has been shown to improve postural ability and functional status. The US Food and Drug Administration has approved baclofen for the treatment of spasticity of cerebral or spinal origin in adult and pediatric patients 4 years or older. Various complications of baclofen pumps are described in the literature. Immediately after surgery, problems from infection can arise and range from superficial skin infections to meningitis and bacteremia. Another early complication includes cerebrospinal fluid leak that can be observed by notable swelling beneath the lumbar incision. Additional problems that arise later are usually from the mechanics of the pump and catheter. Pump-related complications include failure, migration, and flipping. Catheter-related complications include disconnection, occlusion, fracture, or kink. Most of these complications typically lead to baclofen withdrawal, although there are a few case reports of overdose due to mechanical causes. Here we describe 2 cases of individuals experiencing complications of excessive baclofen exposure after significant changes in the atmospheric pressure due to travel involving ambient altitude change. These cases reflect the need to discuss this potential complication with families and patients with baclofen pumps before travel to high elevations.<\/jats:p>","DOI":"10.1542\/peds.2017-3973","type":"journal-article","created":{"date-parts":[[2018,7,5]],"date-time":"2018-07-05T07:36:44Z","timestamp":1530776204000},"source":"Crossref","is-referenced-by-count":5,"title":["Altered Mental Status at High Altitude"],"prefix":"10.1542","volume":"142","author":[{"given":"Sydney","family":"Ryan","sequence":"first","affiliation":[{"name":"Division of Pediatric Emergency Medicine,"},{"name":"Department of Pediatrics, Primary Children\u2019s Hospital, University of Utah, Salt Lake City, Utah; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nanette","family":"Dudley","sequence":"additional","affiliation":[{"name":"Division of Pediatric Emergency Medicine,"},{"name":"Department of Pediatrics, Primary Children\u2019s Hospital, University of Utah, Salt Lake City, Utah; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Green","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Primary Children\u2019s Hospital, University of Utah, Salt Lake City, Utah; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles","family":"Pruitt","sequence":"additional","affiliation":[{"name":"Division of Pediatric Emergency Medicine,"},{"name":"Department of Pediatrics, Primary Children\u2019s Hospital, University of Utah, Salt Lake City, Utah; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Geoffrey","family":"Jackman","sequence":"additional","affiliation":[{"name":"Department of Pediatric Emergency Medicine, Rady Children\u2019s Hospital, San Diego, California"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2018,8,1]]},"reference":[{"issue":"4","key":"2021121020552587500_B1","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/j.pediatrneurol.2008.10.020","article-title":"Intrathecal baclofen infusion for ambulant children with cerebral palsy.","volume":"40","author":"Brochard","year":"2009","journal-title":"Pediatr Neurol"},{"issue":"4","key":"2021121020552587500_B2","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1097\/PEC.0000000000001090","article-title":"Baclofen pumps: uses and complications.","volume":"33","author":"Woolf","year":"2017","journal-title":"Pediatr Emerg Care"},{"issue":"3","key":"2021121020552587500_B3","first-page":"301","article-title":"Analysis of complications in 430 consecutive pediatric patients treated with intrathecal baclofen therapy: 14-year experience [published correction appears in J Neurosurg Pediatr. 2014;13(5):588].","volume":"13","author":"Motto","year":"2014","journal-title":"J Neurosurg Pediatr"},{"issue":"2","key":"2021121020552587500_B4","doi-asserted-by":"crossref","first-page":"232","DOI":"10.3171\/2015.1.PEDS14500","article-title":"Baclofen overdose from possible intrinsic malfunction of SynchroMed II pump.","volume":"16","author":"Davanzo","year":"2015","journal-title":"J Neurosurgery Pediatr"},{"issue":"3","key":"2021121020552587500_B5","doi-asserted-by":"crossref","first-page":"E624; discussion E624","DOI":"10.1227\/01.NEU.0000154133.49781.66","article-title":"An unusual cause of overdose after baclofen pump implantation: case report.","volume":"56","author":"Lew","year":"2005","journal-title":"Neurosurgery"},{"issue":"1","key":"2021121020552587500_B6","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1159\/000315319","article-title":"Malfunction of SynchroMed II baclofen pump delivers a near-lethal baclofen overdose.","volume":"46","author":"Sgouros","year":"2010","journal-title":"Pediatr Neurosurg"},{"issue":"3","key":"2021121020552587500_B7","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1056\/NEJM199401203300308","article-title":"Cerebral palsy.","volume":"330","author":"Kuban","year":"1994","journal-title":"N Engl J Med"},{"issue":"7","key":"2021121020552587500_B8","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1111\/j.1471-4159.1968.tb08959.x","article-title":"The effect of hypoxia on brain gamma-aminobutyric acid levels.","volume":"15","author":"Wood","year":"1968","journal-title":"J Neurochem"},{"issue":"4","key":"2021121020552587500_B9","doi-asserted-by":"crossref","first-page":"C743","DOI":"10.1152\/ajpcell.00019.2011","article-title":"Hypoxia. 3. Hypoxia and neurotransmitter synthesis.","volume":"300","author":"Kumar","year":"2011","journal-title":"Am J Physiol Cell Physiol"},{"issue":"2","key":"2021121020552587500_B10","doi-asserted-by":"crossref","first-page":"e5","DOI":"10.3171\/foc.2006.21.2.6","article-title":"Intrathecal baclofen in the treatment of adult spasticity.","volume":"21","author":"Hsieh","year":"2006","journal-title":"Neurosurg Focus"},{"issue":"11","key":"2021121020552587500_B11","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1038\/sc.2013.43","article-title":"Permanent mechanical deformation of an intrathecal baclofen pump secondary to scuba diving: a case report.","volume":"51","author":"Draulans","year":"2013","journal-title":"Spinal Cord"},{"issue":"4","key":"2021121020552587500_B12","first-page":"281","article-title":"Hyperbaric oxygen therapy: implications for spinal cord injury patients with intrathecal baclofen infusion pumps. 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