Dose:     10 to 75 mg/kg/dose PO, PR

Frequency: Q 6 to 8 hours (lower dose used for prolonged sedation)

Comments: Chloral hydrate is a hypnotic agent without analgesic properties.  It is frequently used for sedation prior to examinations.  It has no analgesic properties; therefore, excitement rather than sedation may occur in patients with pain. For hypnosis prior to a diagnostic procedure a dose of 50 to 75 mg/kg may be given by mouth or rectum. Higher single doses of 80 to 100 mg/kg have been used in infants over one month of age.  If paradoxical excitation follows the dose, the effect will be unresponsive to a subsequent dose. In addition, its taste [bad] and propensity to cause gastric irritation, may make repeated dosing difficult.   The onset of action is 10 to 30 minutes, though the peak effect may not be seen for 60 minutes. Its effects generally last one to two hours following the dose. Irregular absorption in some infants may delay the onset of sedation.   Chloral hydrate has been used for the treatment of agitation and prolonged sedation during mechanical ventilation (recommended dose ranged from 10 to 50 mg/kg Q 6 to 8 hours). Repeated dosing of chloral hydrate in neonates should be avoided because of the possible accumulation of metabolites which may produce excessive central nervous system depression, predispose newborn infants to conjugated and non-conjugated hyperbilirubinemia, decrease albumin binding of bilirubin, and contribute to metabolic acidosis.  Chemical dependence can also result following long-term use. Use with caution in infants with hepatic or renal disease.  More comments on chloral hydrate.

Toxicity:  Chloral hydrate has been used in children since 1894 with few reports of toxicity. Hypotension and/or mild hypoxemia can occur following a single dose. With repeated doses, CNS symptoms including lethargy, decreased activity, and diffuse hypotonia can occur. Obstructive apnea and respiratory depression have been reported though only in infants with underlying CNS or respiratory diseases. Emesis can occur, but there have been no reports of esophageal strictures or gastric necrosis. Adverse reactions associated with chloral hydrate.

Preparation:
PO: Chloral Hydrate (Noctec) is available as a 500 mg/5 ml syrup. May be stored at room temperature in a syringe for 24 hours.

PR: A suppository is available with a content of 324 mg.