Chloral Hydrate-induced Bradycardia in a Child with Global Developmental Delay: A Case Report Emphasizing Toxicity Risk

Chloral hydrate (CH) is a sedative–hypnotic agent historically used for pediatric procedural sedation. While effective, it has a narrow safety margin and has been associated with serious adverse effects, including cardiac arrhythmia and death. We describe an 8-year-old male with global developmental delay (GDD) who developed symptomatic bradycardia after a standard 1 g (40 mg/kg) oral dose of CH for auditory brainstem response (ABR) testing. Postsedation, he became drowsy and bradycardic (heart rate: 40–50 bpm). He required intravenous atropine and pediatric intensive care unit admission for monitoring. He recovered fully within 24 h, and the family was advised to avoid future use of CH. CH’s metabolism to trichloroethanol may result in central nervous system and cardiovascular depression. Children with GDD may have increased susceptibility due to altered pharmacodynamics. Literature reveals higher rates of sedation failure and adverse events with CH compared to safer alternatives such as midazolam and dexmedetomidine. This case highlights that CH, even at therapeutic doses, may precipitate serious adverse events, especially in children with developmental delay. Safer sedative alternatives should be prioritized, and strict, continuous cardiopulmonary monitoring is imperative whenever CH is administered.