Chloral hydrate: the good and the bad

Abstract

Chloral hydrate (CH) is a widely used oral sedative hypnotic drug. Our Regional Poison Control Center frequently receives calls regarding unintentional and intentional chloral hydrate overdose. The chief manifestations of toxicity are due to central nervous system depressant action and its arrhythmogenic potential. After absorption, it is immediately converted to trichloroethanol (TCE), which is the active drug. Levels of TCE at which significant toxicity occurs have been variable. Ingestions of greater than 1.5 to 2.0 g of chloral hydrate have produced symptoms in children and adults. Management includes consideration of gastrointestinal decontamination, supportive care for altered mental status and treatment of arrhythmias. For routine use of chloral hydrate as sedation for pediatric procedures, the American Academy of Pediatrics (AAP) guidelines for sedation in children should be followed to decrease the likelihood of untoward complications.