1 ml

9 cents

Chloral hydrate

  • Paediatric sedation

PO/NG:
100mg/ml liquid in 200ml bottle
Note: Section 29 drug (requires specific notification to Director-General of Health)


ADULT DOSE
Not used in adults

PAEDIATRIC DOSE
PO/NG:
25mg/kg/dose PRN 4-6hrly (do not chart higher regular doses than this; additional stat doses may be given if required)
Often an initial loading dose of 50mg/kg may be needed

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY
Dose in renal impairment [GFR (ml/min)]
<10 Do not use
10-20 10mg/kg PRN 4-6 hourly
>20-50 Dose as in normal renal function

Dose in renal replacement therapy
CAPD Do not use
HD Do not use
CVVHDF 10mg/kg PRN 4-6 hourly

The mechanism of action of chloral hydrate is not known, but the CNS depressant effects are believed to be due to its active metabolite trichloroethanol.

CONTRAINDICATIONS:

  • Patients with marked hepatic or renal impairment

  • Patients with severe cardiac disease.

  • The presence of gastritis.

  • Patients with a known hypersensitivity to the drug.


WARNINGS
Chloral hydrate is genotoxic and may be carcinogenic in mice. Chloral hydrate should not be used when less potentially dangerous agents would be effective.

PRECAUTIONS
General
Chloral hydrate has been reported to precipitate attacks of acute intermittent porphyria and should be used with caution in susceptible patients.

Laboratory Tests:
No tests in addition to routine ICU tests are indicated

Drug/Laboratory Test Interactions:
Chloral hydrate may interfere with copper sulfate tests for glycosuria (suspected glycosuria should be confirmed by a glucose oxidase test when the patient is receiving chloral hydrate), fluorometric tests for urine catecholamines (it is recommended that the medication not be administered for 48 hours preceding the test), or urinary 17-hydroxycorticosteroid determinations.

Chloral hydrate may cause hypoprothrombinaemic effects in patients taking oral anticoagulants
Administration of chloral hydrate followed by intravenous furosemide may result in sweating, hot flashes, and variable blood pressure including hypertension due to a hypermetabolic state caused by displacement of thyroid hormone from its bound state.
CNS depressants are additive in effect and the dosage should be reduced when combinations of sedatives are given concurrently.

Central Nervous System:
Excitement, tolerance, addiction, delirium, drowsiness, staggering gait, ataxia, lightheadedness, vertigo, dizziness, nightmares, malaise, mental confusion, and hallucinations.
Hematological:
Leukopaenia and eosinophilia.
Dermatological:
Allergic skin rashes including hives, erythema, eczematoid dermatitis, urticaria, and scarlatiniform exanthems.
Gastrointestinal:
Gastric irritation and occasionally nausea and vomiting, flatulence, diarrhoea, and unpleasant taste.
Miscellaneous:
Headache, hangover, idiosyncratic syndrome, and ketonuria have been reported.

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