CHLORAL HYDRATE TOXICITY FROM ORAL AND INTRAVENOUS ADMINISTRATION

Background: Overdose from enteric chloral hydrate results in cardiovas cular and central nervous system symptoms. Case Reports: This case ser ies compares and contrasts two cases of oral chloral hydrate overdose with two cases of accidental IV administration. Whereas ingestion of 2 19 mg/kg of chloral hydrate resulted in transient bigeminy, ingestion of up to 960 mg/kg caused torsades de pointes and ventricular fibrilla tion which were effectively treated with defibrillation and a beta blo cker. IV administration in humans does nor appear previously documente d. Two cases of IV administration of a therapeutic chloral hydrate dos e resulted in central nervous system depression and minimal local effe cts at the injection site. Conclusions: Given the high bioavailability of oral chloral hydrate the major determinant of cardiotoxicity may b e the dose rather than the route of administration. Cardiac arrhythmia s due to chloral hydrate appear to be responsive to beta blocker thera py.