| 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). |
| Chemical Properties | White to light yellow powdery solid, non-toxic and tasteless. Soluble in water, insoluble in organic solvents. It has emulsifying, dispersing, suspending, binding and other properties, and can be used as a drainage and retention aid for slurry. |
| Uses | Hetastarch, with a trade name of Hespen, is used widely as volume expanders. An intravenous solution of hydroxyethyl starch is used to prevent shock following severe blood loss caused by trauma, surgery, or other problems. |
| Brand name | Pentaspan (DuPont Merck). |
| General Description | Hydroxyethyl starches (HES) are nonionic starch derivatives and were one of the most frequently used intravascular volume expanders. |
| Biochem/physiol Actions | Analysis of cDNA clones indicates that ribosome binding protein 1 may exist in different forms due to removal of tandem repeats, or partial intraexonic splicing of RRBP1. The form presented here is lacking the canine p180 ribosome-binding domain, NQGKKAEGAQ, which is tandemly repeated close to the N-terminus in other forms that haven′t been fully characterized. RRBP1 has been excluded as a candidate gene in the cause of Alagille syndrome. Alternate splicing results in multiple transcript variants. [provided by RefSeq] |
