Chloral hydrate toxicity

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Background

  • Sedative-hypnotic used for insomnia
  • Binds GABA-A receptor
  • Active metabolite trichloroethanol (TCE)
  • Sometimes still used in pediatrics for children undergoing procedures
  • Rarely used in practice in adult medicine
  • ‘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]

Differential Diagnosis

Sedative/hypnotic toxicity

Evaluation

Evaluation

  • Clinical diagnosis

Workup

Management

Generally supportive care

  • Airway management with intubation and ventilation for CNS depression
  • BP monitoring
  • Monitor for dysrhythmias
  • Decontamination not useful for isolated chloral hydrate ingestions due to rapid 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

  1. Medscape: Chloral hydrate
  2. Whyte IM. Chapter 140 Miscellaneous Anziolytics, Sedatives and Hypnotics; in Dart R, Medical Toxicology (3rd edition), Philadelphia: Lippincott Williams and Wilkins, 2004.
  3. Zahedq A, Grant MH, Wong DT. Successful treatment of chloral hydrate cardiac toxicity with propranolol. American Journal of Emergency Medicine 1999; 17(5):490-491.

Authors:

Amr Badawy