Electrocardiographic changes with segmental akinesia after chloral hydrate overdose
Yves Laurent1, Pierre Wallemacq, Vincent Haufroid
1Department of Intensive Care, Cliniques St-Luc, Université catholique de Louvain, Brussels, Belgium.
The Journal of Emergency Medicine
|March 29, 2006
Summary
A psychiatric patient experienced severe cardiac issues, including ventricular dysrhythmias and ischemic changes, after ingesting chloral hydrate. This case highlights potential sustained cardiac contractility changes from halogenated hydrocarbons.
Area of Science:
- Toxicology
- Cardiology
- Pharmacology
Background:
- Chloral hydrate, a sedative-hypnotic, is occasionally used in psychiatric settings.
- Deliberate overdose can lead to significant toxicity.
- Halogenated aliphatic hydrocarbons are known for potential cardiac effects.
Observation:
- A 25-year-old psychiatric patient ingested 12.5 g of chloral hydrate.
- The patient presented with coma and life-threatening ventricular dysrhythmias shortly after ingestion.
- Electrocardiographic and echocardiographic findings revealed ischemic changes and abnormal left ventricular wall motion on day 3.
Findings:
- Toxic metabolites of chloral hydrate (trichloroethanol, trichloroacetic acid) were detected in urine up to day 7.
- Despite normal coronary angiogram, sustained cardiac abnormalities were observed.
- The case demonstrates that chloral hydrate overdose can cause early dysrhythmias and later sustained cardiac contractility issues.
Implications:
- This case underscores the potential for severe and prolonged cardiac toxicity from chloral hydrate overdose.
- Clinicians should be aware of the risk of delayed and sustained cardiac dysfunction in patients with halogenated hydrocarbon poisoning.
- Further research into the mechanisms of chloral hydrate cardiotoxicity is warranted.
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