Thursday, August 13, 2015

Chloral Hydrate in Infants


Available strength of syrup: 100mg/ml  and 40mg/ml

 Availability
 Justification


Chloral Hydrate 100mg/ml

  • In more recent studies, higher single doses of up to 100 mg/kg have been  used with increased success in children and infants over 1 month of age.
  • Not to exceed 120 mg/kg or 1 g/dose in infants
  • It can be used in adults and children



Chloral Hydrate 40mg/ml

  • When adhering to strict protocols and with adequate monitoring, chloral hydrate sedation for MRI scanning can be safely performed for both preterm and term infants.
  • Chloral hydrate cannot be given as a tablet as it can cause mucosal membrane damage in the alimentary canal.
  • The most frequent adverse effect of chloral hydrate is gastrointestinal irritation and gastric irritation, manifested by nausea, vomiting, diarrhea and stomach pain, besides unpleasant taste and flatulence may also occur.
  • These effects can be minimized by taking chloral hydrate with a full glass of fluid because ileus in an infant has been reported. 
  • Ileus a painful obstruction of the ileum or other part of the intestine.
  • Or it should be administered with feeds, diluted 1:3 with water or other liquid such as fruit juice or ginger.
  • Lower concentration would help to minimize the adverse effect in infants.


Monitoring needed:
  1. Repeat doses should be used with great caution as drug and metabolites accumulate with repeated use; toxicity has been reported after 3 days in a preterm neonate and after 7 days in a term neonate receiving chloral hydrate 40 to 50 mg/kg every 6 hours.
  2. Neonates should be monitored for increased bilirubin concentrations as hyperbilirubinemia may occur due to competition of chloral hydrate metabolites with bilirubin for hepatic glucuronidation. 




References:

Martindale the Extra Pharmacopoeia28

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