Intravenous Plasma volume expander in hypovolaemic shock
Adult: As 6%, 10% solution: Initially, 10-20 mL via slow infusion and with careful monitoring of adverse events. Dose titration and rate of infusion are based on patient’s condition and colloid requirement. Max time interval: 24 hours. Max daily dose: 18 mL/kg.
Hypersensitivity, critically ill patients, sepsis, burns, oliguria or anuria not related to hypovolaemia, undergoing dialysis, pulmonary oedema, CHF, severe hypernatraemia, severe hyperchloremia, pre-existing coagulation or bleeding disorders, intracranial bleeding, organ transplant patients. Renal and severe hepatic impairment.
Patient with risk factors of overexpansion of blood volume (e.g. pulmonary and circulatory problems). Patient undergoing cardiopulmonary bypass. Mild to moderate hepatic impairment. Pregnancy and lactation.
Significant: Anaphylactoid reactions (e.g. bradycardia, tachycardia, bronchospasm), bleeding, fluid overload, haemodilution. Blood and lymphatic system disorders: Anaemia. Injury, poisoning and procedural complications: Wound haemorrhage. Investigations: Increased coagulation time, decreased clotting factors, decreased haematocrit, prolonged prothrombin time, increased serum amylase. Skin and subcutaneous tissue disorders: Pruritus, skin rash.
Monitor blood pressure, heart rate, capillary refill time, cardiac index, haemoglobin, coagulation parameters, renal function, serum electrolyte, LFT, urine output, acid-base balance at baseline and periodically during treatment.
Symptoms: Fluid overload with resulting cardiac and pulmonary failure. Management: Supportive treatment. Administer diuretics as required.
May cause elevated serum amylase and interfere with pancreatitis diagnosis.
Description: Hydroxyethyl starch is a colloidal solution which expands the plasma volume. It consists of amylopectin, a glucose polymer. The glucose units of the polymer are being replaced by hydroxyethyl groups, thus reducing the degradation of amylopectin by α-amylase in the body.
Synonym: HES, tetrastarch. Duration: ≥6 hours. Pharmacokinetics: Distribution: Volume of distribution: 5.9 L. Metabolism: Molecule >50,000 daltons are metabolised by plasma α-amylase. Excretion: Via urine (small molecules <50,000 daltons as unchanged drug and metabolites).
B05AA07 - hydroxyethylstarch ; Belongs to the class of blood substitutes and plasma protein fractions. Used as blood substitutes.
Anon. Hydroxyethyl Starch 130/0.4. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 07/05/2018.Anon. Tetrastarch. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 07/05/2018.Buckingham R (ed). Etherified Starches. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 07/05/2018.Joint Formulary Committee. Tetrastarch. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 07/05/2018.Voluven 10% Solution for Infusion (Fresenius Kabi Limited). MHRA. https://products.mhra.gov.uk/. Accessed 07/05/2018.Voluven 130/0.4 Injection, Solution (Hospira, Inc). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 07/05/2018.