Hextend (Hetastarch Dextrose Electrolytes)

What is Hextend

Hextend is used intravenously as a colloidal plasma volume expander. It has no oxygen-carrying capacity.

Hextend® produces increases in circulating blood volume that are comparable to that of albumin, dextran or Hespan®. Hetastarch has fewer antigenic properties than dextran.

Although Hespan® has been used clinically as an adjunct in the management or prevention of shock caused by hemorrhage, burns, surgery, or trauma; Hextend is currently only indicated in the treatment of hypovolemia during surgery. Hextend® contains 6% hetastarch, dextrose, normal physiological concentrations of sodium and calcium, and slightly lower than normal physiological levels of potassium and magnesium.

Lactate is included for buffering capacity.

Hetastarch is derived from a waxy starch composed almost entirely of amylopectin. Due to a structural similarity to glycogen, hetastarch has hydroxyl ethers introduced into its glucose residues to retard degradation by serum amylase. About 75% of the glucose units are hydroxyethylated.

The average molecular weight of hetastarch is approximately 670,000; at least 80% of the polymer units have a molecular weight between 20,000 and 2,500,000.

Hextend® was approved by the FDA on 3/31/99.

Indications

  • hypovolemia

For use as a plasma expander in hypovolemia during surgery

NOTE: Hextend contains hetastarch, dextrose, and electrolytes. Hextend is not a substitute for blood or plasma.

Side Effects

  1. anaphylactoid reactions
  2. anemia
  3. angioedema
  4. bleeding
  5. bradycardia
  6. bronchospasm
  7. cardiac arrest
  8. chest pain (unspecified)
  9. chills
  10. clotting factor deficiency
  11. coagulopathy
  12. cough
  13. disseminated intravascular coagulation (DIC)
  14. dyspnea
  15. erythema multiforme
  16. fever
  17. flushing
  18. headache
  19. heart failure
  20. hemolysis
  21. hypotension
  22. intracranial bleeding
  23. metabolic acidosis
  24. myalgia
  25. nausea
  26. peripheral edema
  27. prolonged bleeding time
  28. pruritus
  29. pulmonary edema
  30. rash
  31. renal failure (unspecified)
  32. restlessness
  33. sinus tachycardia
  34. sneezing
  35. tachypnea
  36. urticaria
  37. ventricular fibrillation
  38. vomiting
  39. wheezing

Monitoring Parameters

  • activated partial thromboplastin time (APTT)
  • hemoglobin/hematocrit
  • platelet count
  • prothrombin time (PT)
  • serum creatinine/BUN
  • serum electrolytes

Contraindications

  • anuria
  • breast-feeding
  • cardiac disease
  • children
  • coagulopathy
  • corn hypersensitivity
  • diabetes mellitus
  • dialysis
  • geriatric
  • heart failure
  • hepatic disease
  • hydroxyethyl cellulose hypersensitivity
  • hypercalcemia
  • hyperkalemia
  • intracranial bleeding
  • lactic acidosis
  • leukapheresis
  • metabolic alkalosis
  • mortality
  • nephrotoxicity
  • oliguria
  • pancreatitis
  • pregnancy
  • pulmonary edema
  • renal disease
  • renal failure
  • renal impairment
  • respiratory alkalosis
  • sepsis
  • sodium restriction
  • surgery
  • thrombocytopenia
  • von Willebrand’s disease

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