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