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www.ccmjournal.org Critical Care Medicine • Volume 46 • Number 1 (Supplement) Learning Objectives: Acute enteral and intrathecal baclofen withdrawal can be life threatening if not managed appropriately. Symptoms of acute baclofen withdrawal include insomnia, confusion, delirium, hallucinations, hyperthermia, agitation, seizures, spasticity, dyskinesia, and muscle rigidity. Methods: A 61 year old male with a past medical history significant for chronic back pain and spinal stenosis was admitted to the medical intensive care unit with confusion, insomnia, agitation, delirium, and auditory and visual hallucinations. He was on baclofen as an outpatient and his last dose was 9 days prior to admission. He had been experiencing worsening symptoms for 7 days preceding presentation. Vital signs were normal. On physical exam his pupils were dilated, but equal and reactive to light. His speech was tangential and incomprehensible. Serum toxicology was negative. Urine toxicology was positive for benzodiazepine, tetrahydrocannabinol, and tricyclic antidepressants. The patient was taking diazepam and disclosed smoking marijuana prior to admission. Creatine phosphokinase was elevated at 683 U/L. All other laboratory results and imaging were normal. To control his agitation he received 10mg of intravenous (IV) haloperidol, 1mg of IV lorazepam, and 14mg of IV midazolam with minimal improvement; therefore dexmedetomidine was initiated which led to significant clinical improvement. Upon further investigation it was determined that the patient was taking approximately 10 baclofen 20mg tablets a day. According to his pharmacy records he filled 738 baclofen tablets in the previous 12 weeks. His presentation and sudden discontinuation of high dose baclofen led to a diagnosis of baclofen withdrawal. Baclofen was subsequently restarted and dexmedetomidine was weaned off in 36 hours. Results: Treatment of baclofen withdrawal includes supportive care and re-initiating baclofen. Agents utilized for acute agitation including benzodiazepines provide little relief to this patient population. Dexmedetomidine provided significant improvement in this patient’s agitation, delirium, and mental status without suppressing his respiratory drive. There are limited pharmacotherapeutic interventions available to manage symptoms of baclofen withdrawal. There has been only one case report published in the literature that addresses utilization of dexmedetomidine for intrathecal baclofen withdrawal. Dexmedetomidine should be considered for acute enteral baclofen withdrawal.