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Indications and Dosage
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.
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Renal Impairment
Contraindicated.
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Hepatic Impairment
Severe: Contraindicated.
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Contraindications
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.
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Special Precautions
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.
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Adverse Reactions
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. |
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Monitoring Parameters
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.
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Overdosage
Symptoms: Fluid overload with resulting cardiac and pulmonary failure. Management: Supportive treatment. Administer diuretics as required.
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Lab Interference
May cause elevated serum amylase and interfere with pancreatitis diagnosis.
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Action
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). |
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Chemical Structure
 Source: National Center for Biotechnology Information. PubChem Database. Hydroxyethyl starch, CID=16213095, https://pubchem.ncbi.nlm.nih.gov/compound/Hydroxyethyl-starch (accessed on Jan. 23, 2020) |
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Storage
Store between 15-25°C. Do not freeze.
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MIMS Class
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ATC Classification
B05AA07 - hydroxyethylstarch ; Belongs to the class of blood substitutes and plasma protein fractions. Used as blood substitutes.
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References
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.
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