Chloral hydrate (CAS No. 302-17-0) is synthesized by the chlorination of ethanol. The CAS name is 2, 2, 2-trichloro-1, 1-ethanediol. Synonyms include chloral monohydrate,trichloroacetaldehyde hydrate, trichloroacetaldehyde monohydrate, and 1,1,1-trichloro-2,2-dihydroxyethane.
When chloral hydrate is used in clinical medicine, the recommended dose for an adult as a sedative is 250 mg, 3 times a day (equivalent to 10.7 mg/kg body weight per day); the recommended dose as a hypnotic drug is 500–1000 mg (equivalent to 7.1–14.3 mg/kg body weight) (Goodman and Gilman, 1985).
The recommended dose for a child undergoing a medical or dental procedure is 50–100 mg/kg body weight (Badalaty et al., 1990; Fox et al., 1990). A child is typically given a higher dose than an adult because a deeper level of sedation is desired to obtain better cooperation from the child during the medical or dental procedure. There is no evidence that a child is less sensitive than an adult to the sedative effects of chloral hydrate.
Sedative/hypnotic for short-term use only, has no analgesic effects.
Possible Adverse Reactions
1. Gastric irritation
2. Paradoxical excitement
3. Bradycardia up to 24 hours after a single dose in former premature infant.
4. Vasodilation, hypotension, cardiac arrhythmias, myocardial depression.
5. Respiratory depression 6. Indirect hyperbilirubinemia with chronic use
1. Hypersensitivity to chloral hydrate
2. Cardiac disease, gastritis, obstructive airway disease
3. Use with caution in patients with hepatic and/or renal disease due to possible accumulation of active metabolites with chronic administration
4. The metabolite of chloral hydrate has a long elimination half-life. Multiple dosing results in accumulation of this toxic metabolite which may result in arrhythmias
5. The combination of chloral hydrate and furosemide may cause: vasodilation, flushing, tachycardia, hypotension, or hypertension.
1. Assess level of sedation.
2. Onset: 10-20 minutes
3. Peak effect: within 30-60 minutes
4. Oral preparation should be diluted or administered after feeding to reduce gastric irritation.
Special Considerations and Calculations
Chloral hydrate is available in syrup as 100 mg/ml concentration.