hetastarch (Hespan, hydroxyethyl starch)

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:

• hydroxyethyl starch increases risks for kidney damage & mortality in critically ill patients

Contraindications

• hypovolemia, shock or impending shock

pregnancy category = c

safety in lactation = ?

Benefit/risk

• hypovolemia, shock or impending shock
  • number needed to treat (NNT): no benefit
  • number needed to harm
    • 66 for mortality
    • 44 for acute renal failure requiring hemodialysis

Dosage

30-60 g IV as an infusion

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
• boxed warning
  • increased mortality, severe renal injury & risk of bleeding

Mechanism of action

• colloidal properties resemble those of human albumin
• derived from amylopectin
• plasma volume expansion is due to osmotic effects

More general terms

• carbohydrate; sugar
• plasma volume expander