Two Cases of Chloral Hydrate Overdose

Abstract

Chloral hydrate overdose is associated with cardiac toxicities, gastrointestinal tract injuries, central nervous system and respiratory depression. Among all the complications, cardiac arrhythmias are particularly concerning and frequently reported in the literature. The majorities of fatalities from chloral hydrate overdose are due to refractory cardiac arrhythmia. Chloral hydrate-induced arrhythmias are resistant to most of the standard anti-arrhythmic agents but have good response to propranolol. We report two cases of severe chloral hydrate overdose presenting with alarming cardiac rhythm disturbances. One of the patients was successfully treated with intravenous propranolol in the accident and emergency department. The management of chloral hydrate overdose in particular to its cardiac toxicity is reviewed.

Chloral Hydrate Overdose Survived after Cardiac Arrest with Excellent Response to Intravenous β-blocker

“…The other reported side effects are gastric irritation and vomiting. 7,8 The common cause of death due to CH toxicity is cardiac arrhythmia and unrecognized respiratory arrest due to CNS depression. 7…”

“…CH induced cardiac arrhythmias are usually refractory, which are unresponsive to standard antiarrhythmic drugs including amiodarone and lidocaine. 6,7,9,10 However, β-blockers have been reported to be an effective treatment of hydrocarbon-induced cardiotoxicity, including CH. 11-13…”

Ärztliche Compliance hinsichtlich Empfehlungen des Giftinformationszentrums-Nord

“…Vergiftungen mit dem Sedativum Chloralhydrat können neben schwerer ZNS-Depression zu einer Myokard-Sensibilisierung gegenüber Katecholaminen mit schweren, teilweise unbeherrschbaren Arrhythmien führen. Bei persistierender Hypotension und therapieresistenten Herzrhythmusstörungen wird daher die Durchführung einer Hämodialyse empfohlen, die den aktiven Hauptmetaboliten Trichlorethanol eliminieren und letale Verläufe verhindern kann (Ludwigs et al 1996;Sing et al 1996;Wong et al 2009;Nelson et al 2010).…”