hetastarch (Hespan, hydroxyethyl starch)
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Introduction
Tradename: Hespan.
Indications
- blood volume expansion for hypovolemia, shock or impending shock*
- after failure of crystalloid therapy
- blood products are not specifically indicated or are not available
* Caution:
Contraindications
- hypovolemia, shock or impending shock[4][5]
Benefit/risk
- hypovolemia, shock or impending shock[4][5]
- number needed to treat (NNT): no benefit
- number needed to harm[4]
- 66 for mortality
- 44 for acute renal failure requiring hemodialysis[4]
Dosage
500 to 1000 mL IV (6% solution).
500 mL packages.
Dosage adjustment in renal failure
- creatinine clearance < 10 mL/min
- administer usual initial dose, but reduce subsequent doses to 20-50% of initial dose
Pharmacokinetics
- degraded enzymatically to glucose
- excreted in urine
- effects can last for 24 hours, depending upon the dose, clinical state of patient & organ function
elimination via kidney
Adverse effects
- uncommon (< 1%)
- vomiting, fever/chills, bleeding, hypersensitivity, itching pruritus, headaches, muscle pains, peripheral edema, heart failure, circulatory overload, prolongation of PT & PTT, prolongation of clotting time & bleeding time
- risk of acute renal failure needing renal replacement therapy[7]
- boxed warning
- increased mortality, severe renal injury & risk of bleeding[5]
Mechanism of action
- colloidal properties resemble those of human albumin
- derived from amylopectin
- plasma volume expansion is due to osmotic effects
More general terms
References
- ↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 The NNT: Hydroxyethyl Starch for Acute Volume Resuscitation. http://www.thennt.com/nnt/hydroxyethyl-starch-for-acute-volume-resuscitation/
Zarychanski R et al Association of Hydroxyethyl Starch Administration With Mortality and Acute Kidney Injury in Critically Ill Patients Requiring Volume Resuscitation. A Systematic Review and Meta-analysis. JAMA. 2013;309(7):678-688 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23423413 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=1653505 - ↑ 5.0 5.1 5.2 5.3 FDA MedWatch. June 20, 2013 Hydroxyethyl Starch Solutions: FDA Safety Communication - Boxed Warning on Increased Mortality and Severe Renal Injury and Risk of Bleeding
- ↑ Deprecated Reference
- ↑ 7.0 7.1 Mutter TC, Ruth CA, Dart AB. Hydroxyethyl starch (HES) versus other fluid therapies: effects on kidney function. Cochrane Database Syst Rev. 2013 Jul 23;7:CD007594. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23881659