Acute Massive Chloral Hydrate Intoxication Treated with Hemodialysis: A Clinical Pharmacokinetic Analysis

Abstract

A 38 yr old female became comatose and exhibited signs of cardiac toxicity 2 h after ingestion of approximately 38 g chloral hydrate. Hemodialysis was initiated 21 h after ingestion, using twin coils in series, and was continued for 4.5 h. Trichloroethanol, the active metabolite of chloral hydrate, was measured in plasma and dialysate. At 2 h after ingestion, the plasma level was 330 .mu.g/ml (average therapeutic level is 12 .mu.g/ml or less). The predialysis level was 216 .mu.g/ml and after dialysis declined to 141 .mu.g/ml. The pre- and postplasma half-life values were 35 h, while on dialysis the half-life was only 6 h. The average dialysis clearance was 120 ml/min, and the amount of chloral hydrate removed by dialysis was 5.79 g. By the end of dialysis, the patient could respond to verbal commands and was ambulatory 36 h later. Hemodialysis can be a clinically important method of treating chloral hydrate overdose.