Indications
Dextran 40 (low molecular weight dextran) is an intravenous fluid used in hospital to:
- Restore blood volume quickly in shock caused by blood loss, burns, surgery or trauma, until blood is available
- Improve blood flow through small vessels in some vascular and plastic surgery operations
- Help prevent blood clots in the deep veins after certain operations
- Prime the heart and lung machine during heart surgery
It is available on its own or mixed with sodium chloride (normal saline) or glucose (dextrose).
How It Works
Dextran 40 is made of large sugar molecules (a polysaccharide) that stay in the blood vessels and draw water into the bloodstream. This expands the circulating blood volume and raises blood pressure. It also makes the blood thinner and less sticky, reduces clumping of red cells and platelets, and so improves flow through small vessels.
Dosage and Administration
Dextran 40 is given by a doctor or nurse as a slow infusion into a vein. The amount and rate are decided by the doctor according to the condition, body weight, blood pressure, kidney function and fluid balance. Usually the total in the first 24 hours is limited because of the risk of bleeding and kidney problems. A blood sample for grouping and cross-matching should be taken before the infusion starts.
Interactions
It can increase the effect of blood thinners such as Heparin, Warfarin and antiplatelet medicines, raising the risk of bleeding. Medicines that can harm the kidneys, such as Aminoglycosides, may add to the risk of kidney injury. Dextran can interfere with some blood tests, including blood grouping, cross-matching, blood sugar and protein measurements.
Contraindications
It should not be given to people with known allergy to dextran, severe heart failure, fluid overload or fluid in the lungs, kidney failure with little or no urine, severe bleeding disorders or very low platelet counts, or severe dehydration that has not been corrected first.
Side Effects
Possible side effects include:
- Allergic or anaphylactic reactions, which can be severe, especially in the first few minutes
- Fever, skin rash, itching and joint pain
- Increased bleeding tendency
- Fluid overload causing breathlessness
- Reduced kidney function, especially in dehydrated patients
Tell the nurse or doctor at once if you notice itching, hives, tightness in the chest, wheezing, difficulty breathing, dizziness, swelling of the face, or much less urine. These need urgent medical attention.
Pregnancy and Lactation
It is used in pregnancy only when clearly needed, because a severe allergic reaction in the mother could harm the baby. It is not expected to cause problems during breastfeeding, but the doctor will advise.
Precautions and Warnings
Patients are closely watched during the infusion for allergic reactions, blood pressure, urine output and signs of fluid overload. It is used with caution in heart disease, kidney or liver disease, and bleeding problems. Dehydration should be corrected with other fluids so the kidneys are not harmed. Do not use the solution if it is cloudy or contains crystals.
Overdose
Too much can lead to fluid overload, breathing difficulty, bleeding and kidney injury. The infusion is stopped and the doctor gives supportive treatment, sometimes including diuretics or dialysis.
Therapeutic Class
Plasma volume expander; colloid intravenous solution.
Storage
Store below 30°C, do not freeze, and protect from light. Hospital product: store as directed on the pack and out of the reach of children.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.