Information is required concerning administration of chloral hydrate for sedation in children less

Fråga: Information is required concerning administration of chloral hydrate for sedation in children less than 3 years undergoing spirometry, specifically in children with liver- or kidney diseases. Information is also required of drug interactions.

Sammanfattning: Chloral hydrate should not be used in patients with marked renal- or hepatic impairment. This is based on the presumption that metabolites could accumulate leading to toxicity of the drug. Doses for sedation used in children are 25-50 mg/kg daily, divided into 3-4 doses and not exceeding 1.0 gram per dose. Interactions known are mainly with warfarin but also with furosemide.

Svar: Chloral hydrate (Ansopal) was available on the Swedish market from 1965 to 1994, and can presently only be prescribed on license (1). Chloral hydrate is metabolised to trichloroethanol and trichloroacetic acid in the erythrocytes, liver, and other tissues and excreted partly in the urine as trichloroethanol and its glucoronide (urochloralic acid) and as trichloroacetic acid (2).

Chloral hydrate should not be used in patients with marked hepatic impairment on the presumption that its metabolism would be impaired and accumulation could result but there are no data available to show whether this is a significant problem (3). A search in Medline has not provided any more information on this matter.

The metabolites, trichloroacetic acid and glucoronides of trichloroethanol are excreted in the urine and may be accumulated in patients with severe kidney impairment. However, a thorough search in the literature did not result in any information concerning this.

Doses used for sedation in children are 25 mg/kg daily divided into three or four doses. No more than 1.0 gram should be given as a single dose (2,4).

Another source mentions the usual sedative dose for children to be 50 mg/kg (3).

Interaction between chloral hydrate and other substances is not a common problem. It has mainly been seen in combination with anticoagulant therapy. Clinical studies have shown that chloral hydrate could increase the hypoprothrombinemic effect of warfarin in some patients (5).

Interaction of cloral hydrate and intravenous furosemide in a child resulted in symptoms such as facial flushing, tachycardia, diaphoresis and anxiety (6). The same type of symptoms have earlier been described in adults receiving chloral hydrate and furosemide (7).