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South Australian Neonatal Medication Guidelines 

Chloral hydrate   
 100mg/mL oral mixture  

  Department for Health and Wellbeing, Government of South Australia. All rights reserved. 

 

INFORMAL COPY WHEN PRINTED  Page 1 of 3 

OFFICIAL 

 
 

Note: 
Practice poi

This guideline provides advice of a general nature.  This statewide guideline has been prepared to promote and facilitate 
standardisation and consistency of practice, using a multidisciplinary approach.  The guideline is based on a review of 
published evidence and expert opinion.  

Information in this statewide guideline is current at the time of publication.  

SA Health does not accept responsibility for the quality or accuracy of material on websites linked from this site and does not 
sponsor, approve or endorse materials on such links. 

Health practitioners in the South Australian public health sector are expected to review specific details of each patient and 
professionally assess the applicability of the relevant guideline to that clinical situation. 

If for good clinical reasons, a decision is made to depart from the guideline, the responsible clinician must document in the 
patient s medical record, the decision made, by whom, and detailed reasons for the departure from the guideline. 

This statewide guideline does not address all the elements of clinical practice and assumes that the individual clinicians are 
responsible for discussing care with consumers in an environment that is culturally appropriate and which enables respectful 
confidential discussion. This includes: 

  The use of interpreter services where necessary, 
  Advising consumers of their choice and ensuring informed consent is obtained, 
  Providing care within scope of practice, meeting all legislative requirements and maintaining standards of 

professional conduct, and  
  Documenting all care in accordance with mandatory and local requirements 

This is a High Risk Medication  
Potentially toxic medication. An overdose can be rapidly fatal. 

Dose and Indications 

Sedation  

Oral  

8mg/kg/dose every 6 to 8 hours 

 

Procedural sedation 

Oral 

25 to 75 mg/kg as a single dose, given 30 minutes before the procedure 

Preparation and Administration 

Oral 

For oral use, the mixture should be diluted or administered after feeding to reduce gastric 
irritation 

There are TWO STEPS to the dilution process. 

STEP ONE: Draw up the dose of chloral hydrate using the 100mg/mL oral mixture 

STEP TWO: Dilute with an equal volume of water for injection or enteral feed. 

For preterm babies it is preferred to use water for injection as the choice of diluent.  

 

 



South Australian Neonatal Medication Guidelines 

Chloral hydrate  
 100mg/mL oral mixture  
 

 

 
INFORMAL COPY WHEN PRINTED  Page 2 of 3 

OFFICIAL 

 

 

Adverse Effects 

Common 

Gastric irritation, vomiting and diarrhoea (particularly if given on an empty stomach), 
paradoxical excitement 

Respiratory depression, cardiac depression with high or repeated dosing 

 

Rare 

Vasodilation, hypotension, arrhythmias, hyperbilirubinaemia 

 

Monitoring 

? Respiration 

? Heart rate and oxygen saturation 

? Blood pressure 

? Liver function tests (if patient receiving regular dosing) 

If used for procedural sedation monitor for at least 4 hours. Preterm infants have an increased 
risk of bradycardia for up to 24 hours post administration  

Practice Points 

? Chloral hydrate is of no use in the control of pain 

? Onset of action is approximately 15 minutes with duration of action up to 2 hours 

? Should be used with caution in patients with renal or hepatic disease due to the potential 
for accumulation 

? Repeated administration can lead to accumulation 

? May increase the elimination of phenytoin thereby reducing its therapeutic action 

? Chloral hydrate is hyperosmolar. Use caution in in preterm infants at increased risk of 
necrotising enterocolitis 

? Half-life of active metabolite of chloral hydrate may be prolonged in preterm infants, 
increasing the risk of prolonged recovery time and oxygen requirement  

 

 

 

 

  



South Australian Neonatal Medication Guidelines 

Chloral hydrate  
 100mg/mL oral mixture  
 

 

 
INFORMAL COPY WHEN PRINTED  Page 3 of 3 

OFFICIAL 

 

 

Document Ownership &amp; History 

Developed by: SA Maternal, Neonatal &amp; Gynaecology Community of Practice 

Contact: Health.NeoMed@sa.gov.au 

Endorsed by:  Commissioning and Performance, SA Health 

Next review due:  7/12/2026 

ISBN number:  978-1-76083-386-2 

CGQS reference:  NMG009 

Policy history: Is this a new policy (V1)?  N 

 Does this policy amend or update and existing policy?   Y 

 If so, which version?  1.1 

 Does this policy replace another policy with a different title?  N 

 If so, which policy (title)? 

 
 
 

Approval 

Date 
Version 

Who approved New/Revised 

Version 
Reason for Change 

7/12/2021 V2.0 
Domain Custodian, Clinical 

Governance, Safety and Quality 
 

9/3/2018 V1.1 
SA Health Safety and Quality 

Strategic Governance Committee 
New Template 

15/05/201

5 
V1.0 

SA Health Safety and Quality 

Strategic Governance Committee 

Original SA Health Safety and 

Quality Strategic Governance 

Committee approved version 

 



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