Indications
Hydroxyethyl Starch 130/0.4 (often shortened to HES) is an intravenous plasma volume expander. It is used in hospital to treat low blood volume (hypovolaemia) caused by sudden blood loss, for example during surgery or after injury, when crystalloid fluids such as saline alone are not considered enough. Because of safety concerns, its use is now restricted and it is not used in critically ill or septic patients.
How It Works
HES is made of large starch molecules dissolved in a salt solution. When infused into a vein, these molecules stay in the blood vessels and draw water into the circulation. This increases the volume of blood, which helps raise blood pressure and improve blood flow to organs.
Dosage and Administration
Given only by a doctor or nurse in hospital as an intravenous infusion. The amount and rate are decided by the doctor according to blood loss, blood pressure and other measurements, using the lowest effective dose for the shortest time (usually no more than 24 hours). The patient is closely monitored throughout.
Interactions
HES can increase the risk of kidney injury when given with other medicines that may harm the kidneys, such as Aminoglycoside antibiotics. It can add to bleeding risk with anticoagulants such as Heparin. It may affect some laboratory tests, including blood amylase levels.
Contraindications
It must not be used in patients with sepsis, critical illness, burns, kidney failure or kidney replacement therapy, severe liver disease, bleeding disorders, fluid overload or heart failure with fluid overload, brain bleeding, severe high or low sodium or chloride, organ transplant recipients, or allergy to hydroxyethyl starch.
Side Effects
Possible effects include itching (which can appear weeks later and last a long time), kidney injury, bleeding problems, raised blood amylase, dilution of blood counts, and fluid overload. Allergic reactions can occur.
Doctors and nurses watch for signs needing urgent action, such as breathing difficulty, rash or swelling (allergic reaction), unusual bleeding, reduced urine output, or swelling and breathlessness from fluid overload. Patients should tell staff straight away if they feel unwell during the infusion.
Pregnancy and Lactation
Use in pregnancy only if the doctor considers it essential. It is not known if it passes into breast milk; the doctor will advise on breastfeeding.
Precautions and Warnings
Kidney function, blood clotting and fluid balance are monitored, and kidney function is checked for at least 90 days afterwards. It should be stopped at the first sign of kidney injury or bleeding problems. It is used only when crystalloids alone are not enough.
Overdose
Too much may cause fluid overload with breathlessness and swelling, and bleeding problems. The infusion is stopped and treatment such as diuretics is given if needed.
Therapeutic Class
Plasma volume expander (colloid intravenous solution).
Storage
Hospital item: store as directed on the pack, usually below 25°C. Do not freeze. Use only if the solution is clear and the container is undamaged.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.