Indications
Hydroxyethyl Starch (HES) is an intravenous (IV) fluid known as a plasma volume expander or colloid. It is used in hospitals to treat low blood volume (hypovolaemia) caused by sudden blood loss, for example after trauma or during surgery, when salt-based fluids (crystalloids) alone are not considered enough. Because of safety concerns, its use is now restricted, and it should not be used in critically ill patients, patients with sepsis or burns. It is given only by a doctor or nurse.
How It Works
Hydroxyethyl Starch is made from modified starch molecules dissolved in a salt solution. The large molecules stay inside the blood vessels for several hours and hold water there by osmotic pressure. This increases the volume of circulating blood, which helps raise blood pressure and improve blood flow to organs.
Dosage and Administration
It is given as a slow drip into a vein in hospital, with close monitoring. The amount and rate are decided by the doctor according to the patient condition, body weight, blood pressure and laboratory tests. It is used at the lowest effective dose for the shortest time, usually not more than 24 hours, within strict daily limits.
Interactions
It can add to the bleeding risk of blood thinners such as Heparin or Warfarin. Medicines that can harm the kidneys, such as Aminoglycoside antibiotics, may increase the risk of kidney injury. The medical team will review all medicines being given.
Contraindications
- Sepsis (serious body-wide infection), burns or critical illness in intensive care.
- Kidney failure or kidney replacement therapy (dialysis).
- Severe liver disease.
- Bleeding disorders or severe clotting problems; brain bleeding.
- Fluid overload, including lung swelling (pulmonary oedema) and heart failure.
- Allergy to Hydroxyethyl Starch.
- Organ transplant patients.
Side Effects
Possible effects include itching that can start weeks later and last a long time, increased bleeding tendency, raised amylase levels in the blood, and dilution of blood components. It may cause or worsen kidney injury and increase the risk of death in critically ill patients, which is why its use is limited.
Medical staff watch for and treat allergic reactions (rash, swelling, breathing difficulty, falling blood pressure), fluid overload, bleeding and reduced urine. Tell the nurse or doctor straight away if you feel breathless, itchy, faint or notice bleeding.
Pregnancy and Lactation
Safety in pregnancy and breastfeeding has not been fully established. It is used only if the doctor considers it clearly needed.
Precautions and Warnings
- Kidney function, blood clotting and fluid balance are checked during and after treatment.
- Use should stop at the first sign of kidney injury or bleeding.
- Use with care in older people and those with heart disease.
Overdose
Too much can cause fluid overload with breathlessness and lung swelling, and bleeding problems. It is managed in hospital by stopping the infusion and supportive treatment.
Therapeutic Class
Plasma volume expander; colloid IV fluid.
Storage
Store as directed on the pack, usually below 30°C; do not freeze. Use only if the solution is clear and the container is undamaged. Kept by hospitals, 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.