Chloral hydrate toxicity - Revision history

ClaireLewis at 18:04, 16 October 2019

2019-10-16T18:04:11Z

← Revisión anterior		Revisión del 18:04 16 oct 2019
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	''Similar to [[barbiturates]] and [[hydrocarbons]]<ref>Whyte IM. Chapter 140 Miscellaneous Anziolytics, Sedatives and Hypnotics; in Dart R, Medical Toxicology (3rd edition), Philadelphia: Lippincott Williams and Wilkins, 2004.</ref>''		''Similar to [[barbiturates]] and [[hydrocarbons]]<ref>Whyte IM. Chapter 140 Miscellaneous Anziolytics, Sedatives and Hypnotics; in Dart R, Medical Toxicology (3rd edition), Philadelphia: Lippincott Williams and Wilkins, 2004.</ref>''
	*Neuro		*Neuro
	**Sedation, ataxia, coma		**Sedation, [[ataxia]], [[coma]]
	*GI		*GI
	**Erosive gastritis, [[upper gastrointestinal bleeding]], strictures		**Erosive [[gastritis]], [[upper gastrointestinal bleeding]], strictures
	**[[Hepatitis]]		**[[Hepatitis]]
	**Breath smells like pears		**Breath smells like pears
	*Renal		*Renal
	**Nephrotoxicity, proteinuria		**Nephrotoxicity, [[proteinuria]]
	*CV		*CV
	**[[Hypotension]]		**[[Hypotension]]
	**Myocardial depression		**Myocardial depression
	**~~Tachydysrhythmias~~ secondary to catecholamine hypersensitivity: Sinus tachycardia, PVCs, [[ventricular tachycardia]], [[ventricular fibrilation]], [[Torsades]]		**[[Tachyarrhythmias]] secondary to catecholamine hypersensitivity: [[Sinus tachycardia]], [[PVCs]], [[ventricular tachycardia]], [[ventricular fibrilation]], [[Torsades]]
	*~~Resp~~		*Respiratory
	**~~Resp~~ depression, airway obstruction (from muscle relaxation)		**[[Respiratory failure\|Respiratory depression]], airway obstruction (from muscle relaxation)
	**Aspiration pneumonitis		**[[Aspiration pneumonitis]]

	==Differential Diagnosis==		==Differential Diagnosis==
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	*[[ECG]]: Dysrhythmias		*[[ECG]]: Dysrhythmias
	*[[CXR]]:		*[[CXR]]:
	**Pneumonitis or pulmonary edema		**[[Pneumonitis]] or [[pulmonary edema]]
	**Chloral hydrate may be ~~radioopaque~~		**Chloral hydrate may be radiopaque
	*LFTs: monitor for hepatic injury		*[[LFTs]]: monitor for hepatic injury
	*BUN/Cr: monitor for renal injury		*BUN/Cr: monitor for renal injury
	*[[Troponin]]: Myocardial injury		*[[Troponin]]: Myocardial injury
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	*Airway management with intubation and ventilation for CNS depression		*Airway management with intubation and ventilation for CNS depression
	*BP monitoring		*BP monitoring
	**IVF		**[[IVF]]
	**Avoid catecholaminergic [[vasopressors]]		**Avoid catecholaminergic [[vasopressors]]
	*Monitor for dysrhythmias		*Monitor for dysrhythmias
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	**Give or titrate BB until response		**Give or titrate BB until response

	*Decontamination not useful for isolated chloral hydrate ingestions due to ~~rapidl~~ absorption		*Decontamination not useful for isolated chloral hydrate ingestions due to rapid absorption
	*Assume corrosive GI injury until ruled out.		*Assume corrosive GI injury until ruled out.

Kxl328: /* Workup */

2018-11-09T13:08:35Z

Workup

← Revisión anterior		Revisión del 13:08 9 nov 2018
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	===Workup===		===Workup===
	*[[ECG]]: Dysrhythmias		*[[ECG]]: Dysrhythmias
	*[[CXR]]: Pneumonitis or pulmonary edema~~; chloral~~ hydrate may be radioopaque		*[[CXR]]:
			**Pneumonitis or pulmonary edema
			**Chloral hydrate may be radioopaque
	*LFTs: monitor for hepatic injury		*LFTs: monitor for hepatic injury
	*BUN/Cr: monitor for renal injury		*BUN/Cr: monitor for renal injury

Kxl328: /* Workup */

2018-11-09T13:08:06Z

Workup

← Revisión anterior		Revisión del 13:08 9 nov 2018
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	===Workup===		===Workup===
	*[[ECG]]: Dysrhythmias		*[[ECG]]: Dysrhythmias
	*[[CXR]]: Pneumonitis or pulmonary edema		*[[CXR]]: Pneumonitis or pulmonary edema; chloral hydrate may be radioopaque
	*LFTs: monitor for hepatic injury		*LFTs: monitor for hepatic injury
	*BUN/Cr: monitor for renal injury		*BUN/Cr: monitor for renal injury

Rossdonaldson1: /* Management */

2017-09-19T12:57:45Z

Management

← Revisión anterior		Revisión del 12:57 19 sep 2017
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	**Avoid catecholaminergic [[vasopressors]]		**Avoid catecholaminergic [[vasopressors]]
	*Monitor for dysrhythmias		*Monitor for dysrhythmias
	**Treat with beta-blockers to include [[esmolol]] infusion, [[metoprolol]], or [[~~propanolol~~]]<ref>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.</ref>		**Treat with beta-blockers to include [[esmolol]] infusion, [[metoprolol]], or [[propranolol]]<ref>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.</ref>
	**Give or titrate BB until response		**Give or titrate BB until response

Kxl328 at 03:00, 28 February 2017

2017-02-28T03:00:06Z

← Revisión anterior		Revisión del 03:00 28 feb 2017
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	*Binds GABA-A receptor		*Binds GABA-A receptor
	*Active metabolite trichloroethanol (TCE)		*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."		*‘Mickey Finn’ most commonly refers to a mixture of ethanol and chloral hydrate, aka a "knockout drink."

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	==Management==		==Management==
	''Generally supportive care''		''Generally supportive care''
	*Airway management		*Airway management with intubation and ventilation for CNS depression
	*BP monitoring		*BP monitoring
	**IVF~~. Try to avoid~~ catecholaminergic ~~pressors~~		**IVF
			**Avoid catecholaminergic [[vasopressors]]
	*Monitor for dysrhythmias		*Monitor for dysrhythmias
			**Treat with beta-blockers to include [[esmolol]] infusion, [[metoprolol]], or [[propanolol]]<ref>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.</ref>
			**Give or titrate BB until response

	*Decontamination not useful for isolated chloral hydrate ingestions due to rapidl absorption		*Decontamination not useful for isolated chloral hydrate ingestions due to rapidl absorption
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	==External Links==		==External Links==
			*See [http://lifeinthefastlane.com/tox-library/toxicant/anaesthetics/chloral-hydrate/ life in the fast lane's Chloral hydrate toxicity page]
	==References==		==References==
	<references/>		<references/>

	[[Category:Toxicology]][[Category:Pharmacology]]		[[Category:Toxicology]][[Category:Pharmacology]]

Rossdonaldson1: Text replacement - "UGIB" to "upper gastrointestinal bleeding"

2016-08-06T13:57:15Z

Text replacement - "UGIB" to "upper gastrointestinal bleeding"

← Revisión anterior		Revisión del 13:57 6 ago 2016
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	**Sedation, ataxia, coma		**Sedation, ataxia, coma
	*GI		*GI
	**Erosive gastritis, [[~~UGIB~~]], strictures		**Erosive gastritis, [[upper gastrointestinal bleeding]], strictures
	**[[Hepatitis]]		**[[Hepatitis]]
	**Breath smells like pears		**Breath smells like pears

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-22T02:45:01Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Revisión anterior		Revisión del 02:45 22 jul 2016
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	{{Sedatve/hypnotic toxicity types}}		{{Sedatve/hypnotic toxicity types}}

	==~~Diagnosis~~==		==Evaluation==
	===Evaluation===		===Evaluation===
	*Clinical diagnosis		*Clinical diagnosis

Neil.m.young: Text replacement - "0 mg" to "0mg"

2016-07-20T21:26:19Z

Text replacement - "0 mg" to "0mg"

← Revisión anterior		Revisión del 21:26 20 jul 2016
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	*Excretion: Mostly in urine; some feces		*Excretion: Mostly in urine; some feces
	*Potential toxic dose		*Potential toxic dose
	**<6 years old: ~~50 mg~~/kg		**<6 years old: 50mg/kg
	**Adults: 3-10g		**Adults: 3-10g

Neil.m.young at 15:25, 18 May 2016

2016-05-18T15:25:25Z

← Revisión anterior		Revisión del 15:25 18 may 2016
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	<references/>		<references/>

	[[Category:Toxicology]]		[[Category:Toxicology]][[Category:Pharmacology]]

Neil.m.young at 15:23, 18 May 2016

2016-05-18T15:23:56Z

← Revisión anterior		Revisión del 15:23 18 may 2016
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	==Diagnosis==		==Diagnosis==
			===Evaluation===
			*Clinical diagnosis
	===Workup===		===Workup===
	*[[ECG]]: Dysrhythmias		*[[ECG]]: Dysrhythmias
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	*[[Troponin]]: Myocardial injury		*[[Troponin]]: Myocardial injury
	*Consider endoscopy		*Consider endoscopy

	~~===Evaluation===~~
	*Clinical diagnosis

	==Management==		==Management==