Chlormethiazole sedation for critically ill patients in renal failure

Chlormethiazole infusions were used successfully to provide night sedation for 10-19 nights in three patients with renal failure managed by continuous veno-venous haemofiltration with dialysis. Fluid overload has accompanied the use of this drug previously because of its low concentration. The ability to remove large amounts of fluid during haemofiltration dialysis proved to be effective in preventing this. All three patients had impaired liver function and showed evidence of chlormethiazole accumulation after 4-6 days. The combination of progressive reduction in dose and daily withdrawal of infusions prevented a major problem. Acceptance of this technique by the patients was high. Chlormethiazole may be a useful addition to the drugs available to provide sedation in well defined clinical circumstances.