Contra-indications cardiac failure; severe anaemia Side-effects hypersensitivity reactions (including
9 Contra-indications cardiac failure; severe anaemia Side-effects hypersensitivity reactions (including
Water
anaphylaxis) with nausea, vomiting, increased saliva- tion, fever, tachycardia, hypotension and chills Water for Injections A reported
Net price 1-mL amp = 18p; 2-mL amp = 18p; 5-mL amp = 33p; 10-mL amp = 33p; 20-mL amp = 92p; 50-
Isotonic solutions mL amp = £1.91; 100-mL vial = 23p
Indications: acute or sub-acute loss of plasma volume
e.g. in burns, pancreatitis, trauma, and complications of surgery; plasma exchange Available as: Human Albumin Solution 4.5% (50-, 100-, 250- and 400-mL bottles—Baxter); Human Albumin Solution 5%
(250- and 500-mL bottles—Baxter);
5% 9.2.2.2 (100- and 250-mL bottles—Octa- Plasma and plasma substitutes
Octalbin c
pharm); Zenalb c 4.5% (50-, 100-, 250-, and 500-mL
bottles—BPL)
Plasma and plasma substitutes (‘colloids’) contain large molecules that do not readily leave the intravascular
Concentrated solutions (20–25%) space where they exert osmotic pressure to maintain
severe hypoalbuminaemia associated with circulatory volume. Compared to fluids containing elec-
Indications: low plasma volume and generalised oedema where
trolytes such as sodium chloride and glucose (‘crystal- salt and water restriction with plasma volume expan- loids’), a smaller volume of colloid is required to pro-
sion are required; adjunct in the treatment of hyper- duce the same expansion of blood volume, thereby
bilirubinaemia by exchange transfusion in the new- shifting salt and water from the extravascular space. If
born; paracentesis of large volume ascites associated resuscitation requires a volume of fluid that exceeds the
with portal hypertension maximum dose of the colloid then crystalloids can be
given; packed red cells may also be required. Available as: Human Albumin Solution 20% (50- and 100-mL vials—Baxter); Flexbumin c 20% (50- and 100- Albumin solutions, prepared from whole blood, con-
mL bags—Baxter);Octalbin c c 20% (50- and 100-mL tain soluble proteins and electrolytes but no clotting
bottles—Octapharm); Zenalb 20% (50- and 100-mL factors, blood group antibodies, or plasma cholines-
bottles—BPL)
BNF 57
9.2.2 Parenteral preparations for fluid and electrolyte imbalance 525
Plasma substitutes
GELATIN
Dextran, gelatin, and the etherified starches (heta- Note The gelatin is partially degraded starch, pentastarch, and tetrastarch) are macromolecu-
Indications low blood volume (but see notes above) lar substances which are metabolised slowly; they may
Cautions see notes above; pregnancy (Appendix 4)
be used at the outset to expand and maintain blood Side-effects see notes above volume in shock arising from conditions such as burns
Dose
or septicaemia. Plasma substitutes may be used as an . By intravenous infusion , initially 500–1000 mL of a immediate short-term measure to treat haemorrhage
3.5–4% solution (see notes above) until blood is available. They are rarely needed when Gelofusine shock is due to sodium and water depletion because, in c (Braun) A
these circumstances, the shock responds to water and Intravenous infusion , succinylated gelatin (modified electrolyte repletion; see also section 2.7.1 for the
fluid gelatin, average molecular weight 30 000) 40 g management of shock.
(4%), Na + 154 mmol, Cl 120 mmol/litre, net price 500-mL Ecobag Plasma substitutes should not be used to maintain c = £4.70, 1-litre Ecobag c = £9.45
plasma volume in conditions such as burns or peritonitis Geloplasma c (Fresenius Kabi) A where there is loss of plasma protein, water, and elec-
Intravenous infusion , partially hydrolysed and suc- trolytes over periods of several days or weeks. In these
cinylated gelatin (modified liquid gelatin) (as anhy- situations, plasma or plasma protein fractions contain-
5 mmol, ing large amounts of albumin should be given.
drous gelatin) 30 g (3%), Na + 150 mmol, K +
1.5 mmol, Cl 100 mmol, lactate 30 mmol/litre, Large volumes of some plasma substitutes can increase
Mg
net price 500-mL bag = £5.05 the risk of bleeding through depletion of coagulation
Haemaccel c (KoRa) A factors.
Intravenous infusion , polygeline (gelatin derivative, Dextran 70 by intravenous infusion is used for volume
average molecular weight 30 000) 35 g (3.5%), Na + expansion. Dextran may interfere with blood group
6.25 mmol, Cl cross-matching or biochemical measurements, and
145 mmol, K +
5.1 mmol, Ca
145 mmol/litre, net price 500–mL bottle = £5.00 these should be carried out before infusion is begun.
Isoplex c (IS Pharmaceuticals) A
Intravenous infusion Plasma and plasma substitutes are often used in very , succinylated gelatin (modified
fluid gelatin, average molecular weight 30 000) 40 g ill patients whose condition is unstable. Therefore,
0.9 mmol, Cl close monitoring is required and fluid and electrolyte
(4%), Na + 145 mmol, K +
4 mmol, Mg
105 mmol, lactate 25 mmol/litre, net price 500-mL therapy should be adjusted according to the patient’s
bag = £7.53, 1-litre bag = £14.54 condition at all times. Volplex c (IS Pharmaceuticals) A
Intravenous infusion, succinylated gelatin (modified Cautions Plasma substitutes should be used with
fluid gelatin, average molecular weight 30 000) 40 g caution in patients with cardiac disease, liver disease,
(4%), Na + 154 mmol, Cl 125 mmol/litre, net price or renal impairment; urine output should be monitored.
500-mL bag = £4.70, 1-litre bag = £9.09 Care should be taken to avoid haematocrit concentra- tion from falling below 25–30% and the patient should
be monitored for hypersensitivity reactions.
ETHERIFIED STARCH Nutrition
A starch composed of more than 90% of amylopectin Side-effects Hypersensitivity reactions may occur
that has been etherified with hydroxyethyl groups; the including, rarely, severe anaphylactoid reactions. Tran-
terms tetrastarch, pentastarch, and hetastarch reflect sient increase in bleeding time may occur.
and Indications DEXTRAN 70 low blood volume
the degree of etherification
Cautions see notes above; children
blood
Dextrans of weight average molecular weight about Side-effects see notes above; also pruritus, raised ‘70 000’
serum amylase
Indications short-term blood volume expansion
Dose
Cautions see notes above; can interfere with some . See under preparations below laboratory tests (see also above); where possible, monitor central venous pressure; pregnancy (Appen-
Hetastarch
dix 4) Hetastarch (Non-proprietary) A Side-effects see notes above
Intravenous infusion , hetastarch (weight average Dose
molecular weight 450 000) 6% in sodium chloride . See under preparation below
intravenous infusion 0.9%, net price 500-mL bag = £8.00
Hypertonic solution Dose by intravenous infusion , 500–1000 mL; usual daily max. RescueFlow c (Vitaline)
A 1500 mL (see notes above) Intravenous infusion , dextran 70 intravenous infu-
Pentastarch
sion 6% in sodium chloride intravenous infusion 7.5%. Net price 250-mL bag = £28.50
Pentastarch (Non-proprietary) A Cautions see notes above; severe hyperglycaemia and hyperos-
Intravenous infusion , pentastarch (weight average molality
molecular weight 200 000), net price (in sodium Dose initial treatment of hypovolaemia with hypotension
chloride intravenous infusion 0.9%) 10%, 500-mL bag induced by traumatic injury, by intravenous infusion over 2–5
minutes, 250 mL, followed immediately by administration of iso- Dose by intravenous infusion , pentastarch 10%, 500–1000 mL; tonic fluids
max. 1500 mL daily (see notes above)
HAES-steril c (Fresenius Kabi) A Intravenous infusion , pentastarch (weight average molecular weight 200 000) 10% in sodium chloride intravenous infusion 0.9%, net price 500 mL = £16.50 Dose by intravenous infusion , up to 1500 mL daily (see notes above)
Hemohes c (Braun) A Intravenous infusion , pentastarch (weight average molecular weight 200 000), net price (both in sodium chloride intravenous infusion 0.9%) 6%, 500 mL = £12.50; 10%, 500 mL = £16.50 Cautions see notes above
Dose by intravenous infusion , pentastarch 6%, up to 2500 mL daily; pentastarch 10 %, up to 1500 mL daily (see notes above)
Tetrastarch Tetraspan c (Braun) A Intravenous infusion , hydroxyethyl starch (weight average molecular weight 130 000) 6% in sodium chloride 0.625%, containing Na + 140 mmol, K +
4 mmol, Mg
1 mmol, Cl 118 mmol, Ca
2.5 mmol,
acetate 24 mmol, malate 5 mmol/litre, net price 500- mL bag = £13.50 Dose by intravenous infusion , up to 50 mL/kg daily (see notes above) Intravenous infusion , hydroxyethyl starch (weight average molecular weight 130 000) 10% in sodium chloride 0.625%, containing Na + 140 mmol, K +
4 mmol, Mg
1 mmol, Cl 118 mmol, Ca
2.5 mmol, acetate 24 mmol, malate 5 mmol/litre, net price 500-mL bag = £17.50 Dose by intravenous infusion , up to 30 mL/kg daily (see notes above)
Venofundin c (Braun) A Intravenous infusion , hydroxyethyl starch (weight average molecular weight 130 000) 6% in sodium chloride intravenous infusion 0.9%, net price 500-mL bag = £12.90 Dose by intravenous infusion , up to 50 mL/kg daily (see notes above)
Volulyte c (Fresenius Kabi) A Intravenous infusion , hydroxyethyl starch (weight average molecular weight 130 000) 6% in sodium chloride intravenous infusion 0.6%, containing Na + 137 mmol, K +
4 mmol, Mg
1.5 mmol, Cl 110 mmol,
acetate 34 mmol/litre, net price 500-mL bag = £13.50 Dose by intravenous infusion , up to 50 mL/kg daily (see notes above)
Voluven c (Fresenius Kabi) A Intravenous infusion , hydroxyethyl starch (weight average molecular weight 130 000) 6% in sodium chloride intravenous infusion 0.9%, net price 500-mL bag = £12.50 Dose by intravenous infusion , up to 50 mL/kg daily (see notes
above)
Hypertonic solution HyperHAES c (Fresenius Kabi) A Intravenous infusion , hydroxyethyl starch (weight average molecular weight 200 000) 6% in sodium chloride intravenous infusion 7.2%, net price 250-mL bag = £28.00 Cautions see notes above; also diabetes Dose by intravenous injection over 2–5 minutes, 4 mL/kg as a
single dose, followed immediately by administration of appropri- ate replacement fluids