title: Pediatric chloral hydrate poisonings and death following outpatient procedural sedation.
abstract: BACKGROUND
  Chloral hydrate has been used medicinally since the 1800 s as a sedative hypnotic, most commonly for procedural sedation. As it is administered orally and available in a liquid formulation, it is used almost exclusively in pediatric patients despite many safer and more effective alternative agents being available.
  
  
  METHODS
  We present three cases of pediatric chloral hydrate poisoning, all occurring following procedural sedation in outpatient clinic settings and presenting to the emergency department. The ages ranged from 15 months to 4 years of age and all required resuscitation. Unfortunately, the 4-year-old died.
  
  
  CONCLUSIONS
  Choral hydrate is associated with significant adverse effects, including death, and safer alternatives for pediatric procedural sedation should be sought and utilized. There are a number of more effective sedative agents with more predictable pharmacokinetic and safety profiles than chloral hydrate including parenteral and oral agents. The practice of pre-procedure sedation should be performed only in a supervised setting where cardiorespiratory monitoring can occur in all cases.
authors: Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA, spnordt@gmail.com.
authors: Sean Patrick
authors: SP
authors: Nordt
authors: Cyrus
authors: C
authors: Rangan
authors: Madhu
authors: M
authors: Hardmaslani
authors: Richard F
authors: RF
authors: Clark
authors: Carlan
authors: C
authors: Wendler
authors: Michael
authors: M
authors: Valente
mesh_terms: D000553:Ambulatory Care; D002675:Child, Preschool; D002697:Chloral Hydrate / Q000009:adverse effects / Q000506:poisoning*; D003131:Combined Modality Therapy; D062787:Drug Overdose / Q000503:physiopathology / Q000628:therapy*; D004636:Emergency Service, Hospital; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000506:poisoning*; D007223:Infant; D008297:Male; D016896:Treatment Outcome
chemical_list: D006993:Hypnotics and Sedatives; D002697:Chloral Hydrate