With dehydration, infusion of electrolyte solutions is primarily carried out.It is necessary to ensure the introduction of an adequate volume of fluid and electrolytes to meet the needs of the extravascular space, especially when using the 10% hemocoenosis preparation, which is a hyperoncotic solution.
When large volumes of HES are introduced, there is a decrease in hematocrit, hemoglobin, and plasma protein concentration.
A hematocrit of 25% or a hemoglobin content of 8 g / 100 ml is considered to be minimal for the administration of artificial colloids in order to replace the volume of blood plasma in patients with no cardiovascular or pulmonary insufficiency. In patients with cardiovascular, pulmonary insufficiency, sepsis, or in critically ill patients, the hematocrit should not fall below 30%, and the hemoglobin content is below 10 g / 100 ml. With a decrease in hematocrit and hemoglobin below these values, additional administration of blood or erythrocyte mass is required.
When the total plasma protein is below 5 g / 100 ml, albumin administration may be required.
Patients with blood coagulation system diseases, such as hemophilia, von Willebrand syndrome, should be given increased dosages of HES only for vital signs, and also in the absence of alternative medications.It is necessary to compensate for clotting factors and carefully monitor the condition of these patients.
If the kidney function is severely impaired, the dose should be selected in accordance with the glomerular filtration rate or the concentration of plasma creatinine, and adequate fluid volume must be provided.
At the beginning of therapy, it is necessary to monitor the concentration of plasma creatinine. At a threshold concentration of creatinine (1.2-2.0 mg / 100 ml (106-177 mmol / l), which corresponds to compensated renal failure), daily monitoring of fluid balance and diuresis is necessary. Despite normal blood plasma creatinine levels, changes in urine tests may indicate compensated renal damage. If the therapy is carried out for several days, control diuresis 1 - 2 times a day is necessary. The administration of the HES solution should be discontinued if the plasma creatinine concentration during treatment exceeds 2.0 mg / 100 ml.
In cases of deficiency of fibrinogen, the drug should be administered only according to vital indications, until the possibility of transfusion of blood components appears.
In the case of repeated infusion, blood coagulation indicators, in particular bleeding time and activated partial thromboplastin time (ACTTV), should be closely monitored. Particular attention should be paid to patients receiving drugs that affect hemostasis (for example, non-steroidal anti-inflammatory drugs, anticoagulants or
valproic acid) and patients with blood group 0 (1), whose coagulation factor VIII and Willebrand complex are physiologically lower than in patients with other blood groups. Control of electrolyte concentration and fluid balance is required. It is necessary to replace electrolytes in accordance with individual needs.
When the drug is administered under pressure, which may be necessary in case of emergency, all air from the bottle must be removed before the infusion begins.
Infusion of HES can lead to an increase in the activity of α-amylase in blood plasma in laboratory tests. This effect should not be considered as a violation of pancreatic function, it is associated with the formation of a complex of HES with α-amylase and its delayed excretion by the kidney and adrenal pathways.
Bottle for single use. The remaining unused quantities of the drug should be discarded.
Use the solution only if it is transparent and the bottle is not damaged.
After mixing with other compatible preparations in terms of microbiological safety, Hemohes should be used immediately. If the preparation is not used immediately, it can be used no later than 24 hours after mixing, and it is allowed to store it during this period at a temperature of 2 to 8 ° C, only if aseptic conditions are observed during mixing.