Chloral hydrate

Background

• Sedative-hypnotic used for insomnia
• Binds GABA-A receptor
• Active metabolite trichloroethanol (TCE)

Pharmacokinetics

• Onset: 30-60 min
• 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: 50 mg/kg
• Adults: 3-10g

Clinical Features

• Similar to barbiturates and hydrocarbons
• Neuro
  • Sedation, ataxia, coma
• GI
  • Erosive gastritis, UGIB, strictures
  • Hepatitis
  • Breath smells like pears
• Renal
  • Nephrotixicity, proteinuria
• CV
  • Hypotension
• Myocardial depression
  • Tachydysrhythmias
    • Catecholamine hypersensitivity: Sinus tachycardia, PVCs, VT, VF, Torsades
• Resp
  • Resp depression, airway obstruction (from muscle relaxation)
  • Aspiration pneumonitis