ID: 217168 Intrathecal Pump Refill Leading to Altered Mental Status: Diagnosis and Management of a Pocket Fill

Abstract

An 83 year-old male was admitted to the ICU from an outside hospital secondary to altered mental status in the setting of an intrathecal pump. The family reported the patient was in his usual state of health until four days prior when a home health nurse refilled his intrathecal pump with hydromorphone. At the time of pump refill, there was concern for drainage from the pump site and the usual difficulty of fill due to scar anterior to the device. The patient presented that evening to a local hospital due to being sluggish but was sent home with no clear etiology identified or trigger for admission. Three days later, he returned to the local hospital due to altered mental status felt to be medication overdose. Narcan was given causing severe agitation necessitating treatment with ketamine, morphine, and lorazepam. He was then transferred to Emory University for further critical care management and evaluation for possible intrathecal pump infection versus system failure.