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| ==Background==
| | #REDIRECT [[Chloral hydrate toxicity]] |
| *Sedative-hypnotic used for insomnia
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| *Binds GABA-A receptor
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| *Active metabolite trichloroethanol (TCE)
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| *‘Mickey Finn’ most commonly refers to a mixture of ethanol and chloral hydrate, aka a "knockout drink."
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| ==Pharmacokinetics==
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| *Onset: 30-60 min<ref>[http://reference.medscape.com/drug/somnote-chloral-hydrate-342929 Medscape: Chloral hydrate]</ref>
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| *Duration: 4-8 hr
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| *Half-Life: 5 mins (for chloral hydrate)
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| **8-11 hr (active metabolite)
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| *Metabolism: Hepatic metabolism
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| *Excretion: Mostly in urine; some feces
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| *Potential toxic dose
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| **<6 years old: 50 mg/kg
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| **Adults: 3-10g
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| ==Clinical Features==
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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>
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| *Neuro
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| **Sedation, ataxia, coma
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| *GI
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| **Erosive gastritis, UGIB, strictures
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| **Hepatitis
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| **Breath smells like pears
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| *Renal
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| **Nephrotixicity, proteinuria
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| *CV
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| **Hypotension
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| **Myocardial depression
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| **Tachydysrhythmias secondary to catecholamine hypersensitivity: Sinus tachycardia, PVCs, VT, VF, Torsades
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| *Resp
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| **Resp depression, airway obstruction (from muscle relaxation)
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| **Aspiration pneumonitis
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| ==Differential Diagnosis==
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| ==Diagnosis==
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| Clinical
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| *EKG: Dysrhythmias
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| *CXR: Pneumonitis or pulmonary edema
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| *LFTs: monitor for hepatic injury
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| *BUN/Cr: monitor for renal injury
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| *Trop: Myocardial injury
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| *Consider endoscopy
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| ==Management==
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| Generally supportive care
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| *Airway management
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| *BP monitoring
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| **IVF. Try to avoid catecholaminergic pressors
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| *Monitor for dysrhythmias
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| *Decontamination not useful for isolated chloral hydrate ingestions due to rapidl absorption
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| *Assume corrosive GI injury until ruled out.
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| ==Disposition==
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| *Asymptomatic
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| **Observe for 4 hours
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| *Symptomatic
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| **Admit for monitoring
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| **GI: Endoscopy within 24 hrs
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| **CV: Telemetry
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| ==See Also==
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| ==External Links==
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| ==References==
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| <references/>
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