II. Precaution
- Avoid Chloral Hydrate use due to risks and better alternatives
- Chloral Hydrate has an unpredictable time course of sedation
- See Pharmacokinetics below
- Erratic absorption (especially with patient Fasting)
- Recurrent sedation following awakening (related to the metabolite trichloroethanol's long duration of activity)
- If used despite disadvantages, Exercise vigilence
- Limit to short term sedation only
- Avoid repetitive dosing
- Procedural Sedation risks respiratory and cardiovascular depression
- Monitoring is critical
- See Procedural Sedation and Analgesia
- Case reports of pediatric deaths associated with outpatient use
III. Indications
- Pediatric Procedural Sedation
- Common use among pediatric dentists
- Alternative Sedatives are far preferred (see above)
IV. Mechanism
- Sedation only (offers no Analgesic effect)
- Older oral sedation agent similar to Ethanol with GABA-receptor mediated effects
- Chlorinated Hydrocarbon with similar risks in Overdose (see below)
- Rapidly metabolized to the active form, trichloroethanol
- Trichloroethanol has a long duration of action
- Trichloroethanol is responsible for the recurrent sedation following awakening
V. Dosing
- Dosing: 50-75 mg/kg/dose PO or PR
- Maximum: 1000 mg
VI. Pharmacokinetics
- Onset and duration are unpredictable and prolonged if Fasting (decreased and erratic absorption)
- Onset: 30 minutes
- Peak: 30 to 60 minutes
- Duration: 4 to 6 hours
VII. Adverse Effects
VIII. Management: Toxicity or Overdose
- Mechanism
- Chloral Hydrate has similar toxic effects to HydrocarbonOverdose
- Chloral Hydrate sensitizes the Myocardium to Catecholamines
- Presentation
- Respiratory Depression
- Myocardial toxicity and Arrhythmia (especially Ventricular Tachycardia)
- Antidote: Ventricular Tachycardia WITH a pulse
- Beta Blocker (Esmolol is preferred)
- Avoid Epinephrine or other Catecholamines (unless pulseless)
IX. References
- Nordt and Swadron in Majoewsky (2013) EM:Rap 13(5): 6
- Litman (2010) Anesth Analg 110(3): 739-46 [PubMed]