Chloral Hydrate: Safety Risks Still Worth Mentioning

• Published in: Journal of emergency nursing 2018-01, Vol.44 (1), p.81-83
• Main Author: Paparella, Susan F.
• Format: Article
• Language: English
• Subjects: Acidosis; Adolescent; Age; Anesthesia; Child; Child, Preschool; Childrens health; Chloral Hydrate - adverse effects; Dentists; Drug dosages; Drug stores; Emergency medical care; Emergency Nursing - methods; Fatalities; Female; Heart Failure - chemically induced; Humans; Hypnotics and Sedatives - adverse effects; Infant; Male; Medication Errors - prevention & control; Nursing; Patient Safety; Patients; Pediatrics; Pharmacy; Respiratory Insufficiency - chemically induced; Risk; Safety; Toxicity
• ISSN: 0099-1767; 1527-2966
• DOI: 10.1016/j.jen.2017.09.002

An arterial blood gas (ABG) revealed severe respiratory acidosis, and despite extensive resuscitation efforts both prehospital, in the emergency department, and following transfer to a tertiary pediatric center, the child died.6 Another adverse event involved a dentist who prescribed 500 mg (50 mg/kg) of chloral hydrate for a 3-year-old boy and instructed the family to administer the medication at home before arriving in the office for the procedure.According to survey respondents, chloral hydrate remains a primary choice for pediatric sedation because of past experiences with positive outcomes (20%); efficacy (10%); lower cost (8%); inadequate alternatives (8%); and the belief it is as safe as other alternatives (5%).9“While about half (52%) of respondents are not aware of any serious adverse events with chloral hydrate in the past 3 years, about 1 in 5 reported seeing 3 very common adverse events: the patient’s refusal of the medication (spitting out the dose) or vomiting (20%); sedation failures leading to the inability to complete procedures (20%); and prolonged sedation (19%).[...]after minimal sedation has been administered, neonates and pediatric patients should be monitored in an area that is staffed with practitioners trained to monitor sedated children and that is stocked with age-appropriate emergency equipment and medications.10,11 Choral hydrate, when used as an agent for pediatric sedation, involves unique risk.ED practitioners should be keenly aware of management of these patients to avoid adverse effects and ensure safe outcomes.Because of the continued use of this product and associated serious events, ISMP will continue to list chloral hydrate on both the ISMP List of High-Alert Medications in Acute-Care Settings (www.ismp.org/sc?id=2820) and the ISMP List of High-Alert Medications in Community/Ambulatory Healthcare (www.ismp.org/sc?id=2821).9