Pharmacological properties
Colloidal plasma-replacing isotonic solution of hydroxyethyl starch - a high-molecular compound obtained from waxy corn starch by partial hydrolysis of amylopectin with subsequent hydroxyethylation. Due to its ability to bind and retain water, it increases the volume of circulating blood by 85-100% of the injected volume within 4-6 hours after infusion. Restores impaired hemodynamics, improves microcirculation, rheological properties of blood (by reducing hematocrit), reduces blood plasma viscosity, gradually increases colloid-osmotic and central venous pressure in proportion to the injected volume, reduces platelet aggregation and prevents erythrocyte aggregation. The similarity of the structure of hydroxyethyl starch to the structure of glycogen explains the high level of tolerability and the practical absence of adverse reactions. Does not impair kidney function.
T ½ of the drug after a 4-hour infusion (500 ml) is 5-6 hours, the clearance rate is 7.33 ml/min. C max in blood plasma is 11.1 ± 2.7 mg/ml. A small amount of hydroxyethyl starch accumulates in tissues (mainly in cells of the reticuloendothelial system) without toxic effects on the liver, lungs, spleen and lymph nodes. It is broken down by amylase to low-molecular fragments (less than 70,000), which are excreted in the urine (about 70% of the administered dose in 24 hours) and bile.
Indication
hypovolemia; prevention and treatment of hypovolemic shock in burns, injuries, operations; the need for isovolemic hemodilution.
Application
The drug is intended for intravenous infusions. The first 10-20 ml should be administered slowly, monitoring the patient's condition due to the possibility of developing anaphylactoid reactions. The dose, rate and duration of administration are set depending on the severity of blood loss and hypovolemia, and the hematocrit value.
The recommended daily dose for children over 10 years of age and adults for BCC replacement is usually 250-1000 ml. The maximum daily dose is 33 ml/kg (hydroxyethyl starch 2 g/kg). The recommended infusion rate (in the absence of an emergency) is 500 ml over 30 minutes.
In septic and burn shock, the infusion rate should be lower and determined individually in each case. In therapeutic hemodilution, the drug is used according to a multi-day infusion regimen, the daily dose for adults is usually 500 ml. The course dose is 5 l and should be distributed over the treatment period of 4 weeks.
Contraindication
Hypersensitivity, hypervolemia, hyperhydration, traumatic brain injury with increased intracranial pressure, severe heart failure, renal failure with oligo- or anuria, plasma creatinine level more than 2 mg/dl, severe hemorrhagic diathesis.
Side effects
Anaphylactoid reactions (nausea, vomiting, tachycardia, fever, chills, urticaria), flu-like symptoms (headache, muscle pain and lumbar pain), swelling of the lower extremities, enlarged salivary glands, circulatory disorders. extremely rarely - anaphylactic shock (up to cardiac and respiratory arrest). increased amylase levels in blood plasma (not associated with the development of pancreatitis), in some cases, when using the drug in high doses, - prolongation of bleeding time, impaired acid-base status, severe itching of the skin.
Special instructions
Treatment is carried out under the control of BCC, ion content, leukocytes, platelets, hemoglobin, blood coagulation parameters, kidney function. Special caution should be observed in patients with pulmonary edema, decompensated heart failure, impaired kidney function, chronic liver disease, hypofibrinogenemia, hemorrhagic diathesis (it is recommended to pre-administer crystalloid solutions).
At the beginning of therapy, it is necessary to monitor the content of creatinine in the blood plasma. At the limit values of creatinine level 1.2-2 mg/dl or 106-177 μmol/l (compensated renal failure), it is necessary to carefully weigh the possibility and necessity of therapy and it is imperative to carry out frequent monitoring of fluid balance, as well as indicators of urinary retention. It is necessary to take into account the risk of overloading the circulatory system with too rapid administration or administration of the drug in large volumes, and also to bear in mind that hydroxyethyl starch can affect clinical and chemical indicators (glucose content, protein, ESR, fatty acids, cholesterol, sorbitol dehydrogenase, specific gravity of urine). In shock states caused mainly by loss of water and electrolytes (severe vomiting, diarrhea, burns), after initial treatment with the drug, further treatment should be carried out using a balanced electrolyte solution. During treatment, it is necessary to ensure sufficient fluid intake. After intravenous administration of the drug, the level of amylase in the blood increases markedly, which returns to normal after 3-5 days.
Administration of the drug to patients with diabetes is not accompanied by an increase in blood glucose levels, so the drug can be prescribed to this category of patients.
With prolonged daily use of the drug in medium (500 ml/day) or high (1000 ml/day) doses, itchy skin may occur, which is difficult to treat. Itching may appear several weeks after the end of treatment and last for months.
Interactions
Hekodez pharmaceutical is incompatible with solutions of other drugs. Increases the nephrotoxicity of aminoglycoside antibiotics.
Overdose
When the initial symptoms of anaphylactoid reactions appear, the administration of the drug should be stopped. The patient should be placed in a supine position with the upper body lowered, and the airways should be cleared. Adrenaline (1:1000) is administered intravenously, monitoring heart rate and blood pressure (adrenaline administration can be repeated if necessary). Then 5% human albumin solution, 250-1000 mg of prednisolone and antihistamines are administered intravenously. Patients should be under continuous medical supervision, and additional therapeutic measures should be taken depending on the patient's condition.
The introduction of the drug in high doses leads to hemodilution, a decrease in hematocrit, hemoglobin and protein content in the blood plasma. Hemoglobin values below 10 g / 100 ml and hematocrit below 27% are considered critical. When the concentration of total protein in the blood plasma decreases to less than 5 g / dl, albumin administration is indicated. With blood loss of more than 20-25% of the volume of whole blood, additional administration of red blood cells is indicated.
Storage conditions
In a place protected from light at a temperature of 4-25 °C. Shelf life 2 years. Non-wetting of the inner surface of the bottle is not a contraindication for the use of the drug. Do not freeze!
