No

Plasma Volume Expander

Blood volume expander used in the treatment of shock or impending shock when blood or blood products are not available

C

Hypersensitivity to dextran or any component; marked hemostatic defects (thrombocytopenia, hypofibrinogenemia) of all types including those caused by drugs; marked cardiac decompensation; renal disease with severe oliguria or anuria

Hypersensitivity reactions have been reported (dextran 40 rarely causes a reaction), usually early in the infusion. Monitor closely during infusion initiation for signs or symptoms of a hypersensitivity reaction. Dextran 1 is indicated for prophylaxis of serious anaphylactic reactions to dextran infusions. Administration can cause fluid or solute overload. Use caution in patients with fluid overload. Use with caution in patients with active hemorrhage. Use caution in patients receiving corticosteroids. Renal failure has been reported. Fluid status including urine output should be monitored closely. Exercise care to prevent a depression of hematocrit <30% (can cause hemodilution). Observe for signs of bleeding.

<1% (Limited to important or life-threatening symptoms): Mild hypotension, tightness of chest, wheezing

Symptoms include fluid overload, pulmonary edema, increased bleeding time, decreased platelet function

Treatment is supportive, blood products containing clotting factors may be necessary

Store at room temperature; discard partially used containers

Produces plasma volume expansion by virtue of its highly colloidal starch structure, similar to albumin

Onset of action: I.V.: Within minutes to 1 hour (depending upon the molecular weight polysaccharide administered), infusion volume expansion occurs

Elimination: ~75% excreted in urine within 24 hours

I.V. (requires an infusion pump): Dose and infusion rate are dependent upon the patient's fluid status and must be individualized:

Children: Total dose should not exceed 20 mL/kg during first 24 hours

Adults: 500-1000 mL at a rate of 20-40 mL/minute; maximum daily dose: 20 mL/kg for first 24 hours; 10 mL/kg/day thereafter; therapy should not be continued beyond 5 days

Pump prime (Dextran 40): Varies with the volume of the pump oxygenator; generally, the 10% solution is added in a dose of 1-2 g/kg

Prophylaxis of venous thrombosis/pulmonary embolism (Dextran 40): Begin during surgical procedure and give 50-100 g on the day of surgery; an additional 50 g (500 mL) should be administered every 2-3 days during the period of risk (up to 2 weeks postoperatively); usual maximum infusion rate for nonemergency use: 4 mL/minute

Dosing in renal and/or hepatic impairment: Use with extreme caution

Observe patient for signs of circulatory overload and/or monitor central venous pressure; observe patients closely during the first minute of infusion and have other means of maintaining circulation should dextran therapy result in an anaphylactoid reaction

Dextran use in patients with restrictive cardiovascular disease, renal or hepatic impairment should be used with extreme caution. Dextran can also result in an anaphylactoid reaction. Patients should be observed closely during the first several minutes of the infusion in case anaphylactoid reaction occurs.

No information available to require special precautions

No effects or complications reported

Since this medication is generally used in emergency situations, patient education should be appropriate.

Patients should be well hydrated at the start of therapy; discontinue dextran if urine specific gravity is low, and/or if oliguria or anuria occurs, or if there is a precipitous rise in central venous pressure or sign of circulatory overloading

Injection:

6% dextran 75 in dextrose 5% (500 mL)

Gentran®: 6% dextran 75 in sodium chloride 0.9% (500 mL)

Gentran®, Macrodex®: 6% dextran 70 in sodium chloride 0.9% (500 mL)

Macrodex®: 6% dextran 70 in dextrose 5% (500 mL)

Low molecular weight: Gentran®, LMD®, Rheomacrodex®:

10% dextran 40 in dextrose 5% (500 mL)

10% dextran 40 in sodium chloride 0.9% (500 mL)