This document discusses different types of colloid solutions used for volume expansion, including albumin, gelatins, dextrans, starches, and hydroxyethyl starches (HES). It provides details on the properties of each type and considerations for their use. HES solutions are discussed in particular depth, focusing on factors like molecular weight, molar substitution, C2-C6 ratio, and raw materials that determine their effects and safety profile. The document emphasizes knowing the specific properties of the HES product being used and carefully selecting patients, given FDA warnings about their use in sepsis and acute kidney injury.
4. Consists of a single polypeptide chain of
585 amino acids with a molecular weight of
69,000 Dalton
Monodisperse colloid i.e. all particles
have same molecular weight
9. Branched polysaccharide molecule
produced by synthesis using the bacterial
enzyme dextran sucrase from the
bacterium Leuconostoc mesenteroides
(B512 strain) growing in a sucrose medium
Available as dextran-40 & 70 %
Mostly used for improving microcirculation
22. POLYDISPERSE SOLUTIONS
Weight averaged ( Mw ) Vs number averaged (
Mn )
Mw determines viscocity
Mn indicates oncotic pressure
Osmotic effectiveness depends on number of
particles not the molecular size
Available in a range from: 70-670 kDa
23.
24. Represents average number of
hydroxyethyl residues per glucose subunit
0.5 MS means : there are 5 hydroxyethyl
residues in 10 glucose subunits
Higher the MS, more intravascular
retention time
MS determines the category of HES (
heta, hexa, penta, tetra etc )
27. Not described in product literature
Describes the pattern of hydroxy-ethylation
Hydroxy-ethylation of glucose subunits is
guided towards C2 & C6 carbon atoms
HES products with high C2-C6 ratio
undergo slow degradation
28.
29.
30.
31.
32.
33.
34. Low MW
Low MS
Low C2-C6 ratio
Faster clearance
Less accumulation
Lesser side effects
35.
36. TetraHES with similar nomenclature made
with different raw materials
Bioequivalance between two tetraHES with
similar nomenclature made with different
raw material might not be same or
comparable
37. Waxy maize: 98% highly branched chained
amylopectin ( eg. VOLUVEN/ VOLULYTE )
Potato starch: heterogenous mixture of 75%
amylopectin and remaining with linear chain
amylose LOW BRANCHING ( eg.
TETRASPAN )
38.
39. High esterified phosphate group in potato
starch HES contributes to more viscosity ,
due to more branching
Clinical significance not clear
44. KNOW YOUR HES
Select your patient properly
FDA warns use in sepsis and in AKI
TEST DOSE ( 15-20ml IV, before bolus )
Keep a watch on total volume of HES
infused