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Overdose with chloral hydrate: a pharmacological and therapeutic review
1St. Vincent's Hospital, Darlinghurst, NSW.
Insights
Chloral hydrate overdose can cause severe cardiac arrhythmias resistant to standard treatment. Intravenous propranolol is proposed as a first-line therapy, and discontinuation of chloral hydrate use is suggested due to its toxicity.
Area of Science:
- Toxicology
- Cardiology
- Pharmacology
Background:
- Chloral hydrate is a sedative-hypnotic with known toxicity.
- Overdoses can lead to severe and life-threatening complications.
Abstract:
The purpose of this review is to highlight the toxicity of chloral hydrate and to review the management of overdoses with chloral hydrate. Three patients are presented in whom life-threatening cardiac arrhythmias dominated the clinical presentation. These arrhythmias were resistant to standard antiarrhythmic therapy. Also, we have reviewed selected features in eight patients who took overdoses of chloral hydrate who were admitted to an intensive care unit between 1981 and 1988. The pharmacology and toxicology of chloral hydrate are discussed with particular reference to the cardiac arrhythmias that are seen with overdosage. A proposed management scheme is detailed, including intravenously-administered propranolol as the preferred first-line antiarrhythmic agent. A case may be made for the discontinuation of the usage of chloral hydrate.