Related Experiment Videos
Chloral hydrate sedation in neonates and infants--clinical and pharmacologic considerations
L D Reimche1, K Sankaran, K W Hindmarsh
1Perinatal Research Laboratory, College of Pharmacy, University of Saskatchewan, Saskatoon, Canada.
Insights
Chloral hydrate metabolism in infants can lead to harmful metabolite accumulation. Caution and monitoring are advised for preterm infants due to potential bilirubin competition.
Area of Science:
- Pharmacology
- Neonatal Medicine
- Toxicology
Background:
- Chloral hydrate is a long-used sedative with limited data on infant metabolism.
- Understanding chloral hydrate's metabolic fate in neonates and infants is crucial.
Purpose of the Study:
- To quantify chloral hydrate and its metabolites in infants.
- To investigate potential adverse effects and drug interactions in this population.
Main Methods:
- Quantification of chloral hydrate and metabolites in 12 neonates and 2 infants.
- Analysis of metabolite accumulation and potential competition for hepatic glucuronidation.
Main Results:
- Trichloroacetic acid and trichloroethanol accumulated in compromised infants.
- Indirect evidence suggests trichloroethanol competes with bilirubin for hepatic glucuronidation in preterm infants.
Conclusions:
- Multiple chloral hydrate doses require caution in preterm infants.
- Frequent monitoring of serum bilirubin is recommended.
- The detailed metabolism of chloral hydrate is discussed.
Abstract:
Chloral hydrate has been used clinically for over 100 years. There is significant paucity of information regarding chloral hydrate metabolism in neonates and infants. Chloral hydrate and its various metabolites were quantitated in 12 neonates and 2 infants at prescribed time intervals. The analysis of the data indicates accumulation of trichloroacetic acid and trichloroethanol in tissue of compromised infants. There is indirect evidence of competition for hepatic glucuronidation for bilirubin with trichloroethanol in ill preterm infants. Multiple dosing of chloral hydrate in preterm infants should be used with caution and frequent monitoring of serum bilirubin concentrations is indicated in such cases. The mechanism of chloral hydrate metabolism is discussed in detail.