PLASMA VOLUME EXPANDERS

ACTIONS AND USES: Dextran 40 is a polysaccharide that is too large to pass through capillary walls. It is similar to dextran 70, except dextran 40 has a lower molecular weight. Dextran 40 acts by raising the osmotic pressure of the blood, thereby causing fluid to move from the interstitial spaces of the tissues to the intravascular space (blood). Given as an IV infusion, it has the capability of expanding plasma volume within minutes after administration. Cardiovascular responses include increased blood pressure, increased cardiac output, and improved venous return to the heart. 

PHARMACOKINETICS AND INDICATIONS: Dextran 40 is excreted rapidly by the kidneys. Indications include fluid replacement for patients experiencing hypovolemic shock due to hemorrhage, surgery, or severe burns. When given for acute shock, it is infused as rapidly as possible until blood volume is restored. Dextran 40 also reduces platelet adhesiveness and improves blood flow through its ability to reduce blood viscosity. These properties have led to its use in preventing deep venous thromboses and postoperative pulmonary emboli. Pulmonary embolism

ADMINISTRATION ALERTS:

1) Emergency administration may be given 1.2 to 2.4 g/min.

2) Non-emergency administration should be infused no faster than 240 mg/min.

3) Discard unused portions once opened because dextran contains no preservatives.

4) Pregnancy category C

ADVERSE EFFECTS: Vital signs should be monitored continuously during dextran 40 infusions to prevent hypertension caused by plasma volume expansion. Signs of fluid overload include tachycardia, peripheral edema, distended neck veins, dyspnea, or cough. A small percentage of patients are allergic to dextran 40, with urticaria being the most common sign.

CONTRAINDICATIONS: Dextran 40 is contraindicated in patients with renal failure or severe dehydration. Other contraindications include severe congestive heart failure (CHF) and hypervolemic disorders.

INTERACTIONS:

Drug–Drug: There are no clinically significant interactions.

Treatment of Overdose: For patients with normal renal function, discontinuation of the infusion will result in reduction of adverse effects.

RELATED;

1. ALKALINITY AND ACIDITY OF BODY SYSTEMS

2.  HEMATOLOGICAL CONDITIONS

REFERENCES