Open AccessHES: Is There a Maximal Dose?
Author(s) -
Boldt Joachim
Publication year - 2001
Publication title -
transfusion alternatives in transfusion medicine
Language(s) - English
Resource type - Journals
eISSN - 1778-428X
pISSN - 1295-9022
DOI - 10.1111/j.1778-428x.2001.tb00041.x
Subject(s) - hydroxyethyl starch , medicine , pharmacodynamics , hemostasis , gelatin , albumin , dextran , dosing , pharmacokinetics , pharmacology , anesthesia , chromatography , surgery , chemistry , biochemistry
SUMMARY The pharmacokinetics and pharmacodynamics of the various solutions available for volume replacement therapy differ widely. The natural colloid albumin and the synthetic colloid gelatin can be used in an unlimited manner according to manufacturer instructions. By contrast, dextran and the various hydroxyethyl starch (HES) preparations have manufacturer‐recommended dose limitations. The physical and chemical characteristics of HES are defined by concentration, degree of substitution (DS), mean molecular weight (Mw), and the C2/C6 ratio of substitution. Currently specified dose limitations to minimize unwanted side effects on hemostasis, accumulation and storage are 20 mL/kg for 10% HES 200/0.5 and 33 mL/kg for 6% HES 200/0.5. Other possible HES‐associated side effects are not dose‐dependent (e.g., anaphylaxis) or are similar to those produced by other substances used for volume replacement (e.g., dilution of clotting factors). A new HES, 6% HES 130/0.4, with a lower Mw and a lower DS is a promising substance endowed with improved pharmaco‐chemical properties. It shows significantly less accumulation even after repeated dosing over several days. Thus, there may be no dose limitations at the current level with this new HES preparation.