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Questions And Answer

• Clinical Uses

  Hydroxyethyl starch is often used as a plasma substitute for therapy of hypo- volemia after trauma, burns, infections or during surgery.It is also widely used for hemodilution treatment of cerebral ischemia and of retinal, otogenic or peripheral perfusion disturbances.In treatment of cerebral ischemia, a hypervolemic therapy protocol has been shown to be more effective than an isovolemic infusion. Another indication is the hyperdynamic treatment of vasospasm in subarachnoid hemorrhage.Some of these indications require relatively high dosages to ensure efficacy of therapy.However, during continuous treatment with large volumes of HES, disturbances of coagulation and hemor- rhagic complications are not uncommon. Trumble et al. reported bleeding complications during hetastarch therapy of vasospasm in subarachnoid hemorrhage patients and recommended the use of plasma protein fraction instead.Van den Brink observed coagulopathy under therapy with highly sub- stituted medium molecular weight HES.These disturbances of the coagulation sys-tem were found to be due to an acquired von Willebrand syndrome.;

• lnstructions for Use

  Suspend in saline(0.9%) or 5% dextrose solution for use. Administer slowly in 5-mL/kg increments to small animals,then reassess and increase the dose to rates listed in the dosing section.Hydroxyethyl starch solutions are used in critical care situations and infused via CRI.;

• Adverse Reactions and Side Effects

  Most of the serious adverse effects reported, such as kidney injury and coagula- tion abnormalitics,have been observed in human studies and have not been docu- mented with clinical use in veterinary medicine.The use in people has become controversial and caution is advised when using these products in animals,with attention to the most commonly reported problems in people.Hetastarch may cause allergic reactions and hyperosmotic kidney injury.Hydroxyethyl starch solu- tions may affect platelet function and produce coagulation abnormalitics at clini- cally relevant doses for up to 24 hours.The high-molecular-weight hetastarch may alter coagulation and alter viscoelastic measurements and fibrinolysis.Do not use in patients with bleeding problems or preexisting coagulopathies. High-molecular- weight products (10% solutions) have molecular weight more than 200 kDa (kilodaltons)and are associated with higher risk of kidney injury.Tetrastarch solu- tions also may have less tendency to cause coagulopathics than hetastarch.There- fore the current recommendation is to use tetrastarch solutions of 6% and reduced molecular weight(130 kDa).;

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