The use of hydroxyethyl starch solution in medicine has proven effective. For over twenty years, the solution has been actively used to treat patients whose condition is accompanied by a decrease in the volume of circulating blood. A solution for infusion of hydroxyethyl starch 6% is also effective if, for one reason or another, the ratio of blood plasma and red blood cells, platelets, white blood cells is violated. In some cases, a timely delivered dropper with the drug can save the patient's life. Sometimes the drug is administered not by drip, but is administered intravenously - it all depends on the conditions in which the patient is and the clinical picture of his health.
Composition and form of release
The drug is available in the form of a solution for infusion. The volume of each bottle is 250 ml or 500 ml. 1 g of solution contains 60 g of hydroxyethyl starch. Trade names for the drug are different - there are many solutions that include this particular component.
The composition is administered intravenously, in a jet or drip manner. Violation of hemodynamics can be more or less - accordingly, the dosage in each individual case will be different. As a rule, the duration of therapy and the required dosage are set based on the hematocrit value.
Pharmacological action of the drug
The hydroxyethyl starch infusion solution is a starch-based fluid treated in a special way. This is a high molecular weight compound that consists almost entirely of glucose residues obtained by polymerization.
The most important properties that affect the effectiveness of the drug and the duration of treatment are the average molecular weight and degree of substitution of hydroxyethyl starch. Analogues of the drug have exactly the same structural formula. About 20 analogs are presented on the pharmacological market, but only some of them are widely used in medicine. The therapeutic effect is achieved due to the high similarity of the structural formula of hydroxyethyl starch with glycogen. This allows you to use the substance in order to improve the composition of the blood and restore it to acceptable values. The use of hydroxyethyl starch (the trade name may differ) allows you to repair damaged cells and thereby restores impaired hemodynamics, improves microcirculation, rheological properties of blood (by reducing the hematocrit), and reduces plasma viscosity. Since the structural formula of the substance is as close as possible to the natural formula, the hydroxyethyl starch is tolerated relatively well, with a minimal amount of side effects.
The drug has long been used in medicine for a variety of diseases and conditions, but it has proven itself best when used as part of complex therapy for hypovolemic conditions and if the patient has lost a large amount of blood for one reason or another.
Indications for use of the drug
Instructions for use with hydroxyethyl starch provide for the use of the drug in the following cases:
- hemorrhagic, traumatic or septic shock and the resulting hypovolemic state;
- blood loss, including as a result of surgery;
- violation of blood microcirculation;
- arterial hypotension due to surgery;
- acute hypotension;
- when carrying out isovolemic hemodilution, the drug is also actively used;
- as part of complex (combined) therapy for venous thrombosis.
As a rule, hydroxyethyl starch preparations are used under stationary conditions. At home, only a qualified specialist can deliver a dropper and provide drip administration. Conditions requiring hydroxyethyl starch therapy require urgent medical attention.
Hypovolemia - symptoms, causes and therapy
Hypovolemic condition is one of the most common, in which therapy with hydroxyethyl starch is carried out. This is a persistent and progressive decrease in the volume of circulating blood in the patient's body. Due to this condition (in the absence of qualified medical care), death can occur. Note: in a normal, healthy and non-pathological condition in adult women, the total blood volume is 58–64 ml per 1 kg of body weight, in men - 65–75 ml / kg.
Causes of hypovolemia:
- blood loss caused by injuries, injuries, surgical intervention, chronic diseases (some types of pathologies of the gastrointestinal tract can cause internal bleeding - this condition is a direct threat to the patient's life);
- loss of a significant amount of fluid by the body (this condition can develop due to burns on a large area of the body, polyuria, ongoing diarrhea, severe vomiting in case of serious poisoning);
- sharp, sudden expansion of blood vessels with a change in the rhythm of the circulating blood;
- various kinds of shock conditions provoked by injuries or chronic diseases of the cardiovascular system (heart attack, stroke, etc.);
- deficiency of incoming fluid (plain water) into the patient’s body against the background of the development of severe inflammatory and infectious processes, a similar condition can also occur due to the patient’s prolonged stay in a room with high air temperature).
Depending on the special medical indicator - hematocrit - there are several stages of hypovolemia, while the instruction for hydroxyethyl starch warns that the drug has a relatively greater or lesser effectiveness, depending on the type of pathology:
- normocytemic is a general gradual decrease in the volume of circulating blood, while it should be borne in mind that the ratio of plasma to uniform elements remains almost completely intact;
- oligocytemic - a decrease in the number of blood cells, i.e., it can be said that the value of hematocrit decreases;
- polycythemic - hematocrit is higher than normal, as the indicator of plasma volume decreases.
Any of the stages of hypovolemia is very dangerous for the patient, for whatever reason it occurs. If you suspect a similar condition, you can not self-medicate, even if it is possible to put a dropper with hydroxyethyl starch at home. The patient needs long-term rehabilitation after a serious blood loss, he needs constant quality control of the condition, which can only be done by a professional.
List of contraindications for use
Instructions for use with hydroxyethyl starch (for all preparations that contain this active substance, it is almost completely analogous) reports that there are the following contraindications for use:
- Individual high sensitivity to the active element.
- TBI, which is accompanied by increased intracranial pressure (ICP).
- If there is a suspicion of intracranial bleeding, as a rule, the use of the drug is strictly prohibited.
- Arterial hypertension (in contrast to hypotension, which is indicated in the list of indications for the use of drugs with hydroxyethyl starch as the main active substance).
- Chronic heart failure.
- Renal failure in both acute and chronic form (respectively, if the patient is on hemodialysis, the use of drugs with hydroxyethyl starch in the composition is also prohibited).
- Acute left ventricular failure.
- Pulmonary edema of a cardiogenic nature.
- Thrombocytopenia.
- Allergy and intolerance to starch.
- Children's age up to 10 years.
- Hyperhydration, coagulopathy, hypocoagulation, dehydration.
- Hypofibrinogenemia.
There are also relative contraindications for use. Instructions for use with hydroxyethyl starch (this applies to all drugs that contain this active substance) indicates that the relative contraindications for use are as follows:
- chronic diseases of the liver, pancreas, kidneys;
- children under the age of 10;
- von Willebrand disease;
- chronic diseases of the urinary system.
What side effects does the drug cause?
The drug has exactly the same side effects, regardless of what its trade name is. Hydroxyethyl starch analogues are represented by more than a dozen drugs, however, when using them, the possibility of developing the following side effects should be considered:
- tachycardia (in case of complaints about the speed and quality of the heart rhythm from the patient, administration should be stopped immediately);
- allergic reactions are possible: urticaria, skin itching, nausea, dermatitis;
- from the digestive system, the development of diarrhea, nausea is possible;
- increased plasma amylase (not associated with manifestations of pancreatitis);
- a relatively rare side effect is the appearance of skin itching, which is not accompanied by rashes and dermatitis;
- when using high doses, prolongation of bleeding time is possible.
Interaction with other medicinal substances
Before starting the introduction, you should make sure that it is possible in parallel with the already taken medicines - this is warned by the instructions for the use of hydroxyethyl starch. The active substance can antagonize with the components of other drugs. If for some reason they do not combine, many serious side effects may develop. The name "Hydroxyethyl starch INN" is one of the most common, but it should be noted that doctors often use its analogues - it is "Volekam", "Gemokhes", "Voluven", "Hydroxyethyl starch-Eskom."
The drug should not be mixed in one dropper bottle with any other solutions and formulations.
When used concurrently with heparin, the risk of increased bleeding increases. Therefore, such a combination is undesirable.
In parallel with beta-blockers and vasodilators, it should be borne in mind that blood pressure differences can be diagnosed, heart rate may vary.
The use of drugs with hydroxyethyl starch in the composition can have a significant impact on various types of blood tests - in particular, on the amount of fatty acids, the amount of protein, ESR. The specific gravity of urine can also change against the background of regular use.
Trade names for hydroxyethyl starch
Preparations with hydroxyethyl starch in the composition can have the following names:
- "N-hydroxyethyl starch";
- "Hydroxyethyl starch";
- "Hydroxyethyl starch 200 / 0.5";
- "Gemoches 10%";
- "Venofundin";
- "Hydroxyethyl starch 130 / 0.4";
- Hydroxyethyl Starch-Eskom;
- Hydrael 130
- "Wolek";
- "Volekam" GES-200;
- "Voluwen";
- "HyperHAES Infucol";
- "Gemohes GETA-SORB";
- Tetraspan
- "Stabizol HES";
- Reftan GES;
- Plazmastabil 200;
- Plazmalin;
- "Infucol";
- "Hesplasm."
The name, as a rule, does not reflect the composition or percentage of the substance used, so you should carefully study the instructions. As mentioned above, the drug is usually used in an inpatient setting. Most commonly used drugs are those with the following trade names for hydroxyethyl starch:
- "Wolek";
- Plazmalin;
- "Gemoches."
"Volekam" - an analog of hydroxyethyl starch
Hydroxyethylated starch is used as the main active ingredient in the manufacture of this preparation.
Pharmacological action: increases the rheological properties of the blood composition by reducing the hematocrit, reduces the viscosity of the plasma. With regular administration through a dropper, it restores microcirculation.
It is widely used in modern medicine for bleeding, hypovolemic conditions. It has contraindications and side effects that have been described above. A number of drugs that have hydroxyethylated starch as the main active ingredient, they are common. The use of the drug should not be carried out by the patient on his own, without a preliminary examination by a doctor and a prescription with the recommended dosage.
"Gemokhes" - the principle of action and indications for use
"Gemokhes" is another analogue with hydroxyethylated starch in the composition. Able to reduce hematocrit, lowers plasma viscosity. Like the analogues listed above, it is used in medicine as an independent tool or as part of a combined course of treatment for conditions during which the blood composition is disturbed, after heavy bleeding, the body loses a large amount of fluid, with severe dehydration and impaired blood composition due to it.
Since hydroxyethylated starch acts as the main active ingredient in the preparation, the instructions for use with Gemokhes are almost completely analogous to such preparations as N-hydroxyethyl starch, Hydroxy Ethyl Starch 200 and the like. Self-use of the drug is not recommended. As a rule, it is used in a hospital with heavy blood loss, dehydration, etc.