Chloral hydrate toxicity
Revision as of 02:45, 22 July 2016 by Neil.m.young (talk | contribs) (Text replacement - "==Diagnosis==" to "==Evaluation==")
Background
- Sedative-hypnotic used for insomnia
- Binds GABA-A receptor
- Active metabolite trichloroethanol (TCE)
- ‘Mickey Finn’ most commonly refers to a mixture of ethanol and chloral hydrate, aka a "knockout drink."
Pharmacokinetics
- Onset: 30-60 min[1]
- Duration: 4-8 hr
- Half-Life: 5 mins (for chloral hydrate)
- 8-11 hr (active metabolite)
- Metabolism: Hepatic metabolism
- Excretion: Mostly in urine; some feces
- Potential toxic dose
- <6 years old: 50mg/kg
- Adults: 3-10g
Clinical Features
Similar to barbiturates and hydrocarbons[2]
- Neuro
- Sedation, ataxia, coma
- GI
- Renal
- Nephrotoxicity, proteinuria
- CV
- Hypotension
- Myocardial depression
- Tachydysrhythmias secondary to catecholamine hypersensitivity: Sinus tachycardia, PVCs, ventricular tachycardia, ventricular fibrilation, Torsades
- Resp
- Resp depression, airway obstruction (from muscle relaxation)
- Aspiration pneumonitis
Differential Diagnosis
Sedative/hypnotic toxicity
- Absinthe
- Barbiturates
- Benzodiazepines
- Chloral hydrate
- Gamma hydroxybutyrate (GHB)
- Baclofen toxicity
- Opioids
- Toxic alcohols
- Xylazine toxicity
Evaluation
Evaluation
- Clinical diagnosis
Workup
- ECG: Dysrhythmias
- CXR: Pneumonitis or pulmonary edema
- LFTs: monitor for hepatic injury
- BUN/Cr: monitor for renal injury
- Troponin: Myocardial injury
- Consider endoscopy
Management
Generally supportive care
- Airway management
- BP monitoring
- IVF. Try to avoid catecholaminergic pressors
- Monitor for dysrhythmias
- Decontamination not useful for isolated chloral hydrate ingestions due to rapidl absorption
- Assume corrosive GI injury until ruled out.
Disposition
Asymptomatic
- Observe for 4 hours
Symptomatic
- Admit for monitoring
- GI: Endoscopy within 24 hrs
- CV: Telemetry
See Also
External Links
References
- ↑ Medscape: Chloral hydrate
- ↑ Whyte IM. Chapter 140 Miscellaneous Anziolytics, Sedatives and Hypnotics; in Dart R, Medical Toxicology (3rd edition), Philadelphia: Lippincott Williams and Wilkins, 2004.