Dextran - instructions for use, dose, side effects, contraindications

Dextran is a polymer of glucose, it is a polyfunctional plasma-substituting solution, restores normal hemodynamics, increases the volume of fluid in the bloodstream, improves microcirculation, reduces blood viscosity and aggregation of blood elements. Has detoxication, anti-shock and plasma-substituting action.

The osmotic mechanism stimulates diuresis (filtered in the glomeruli, creates a high oncotic pressure in the primary urine and prevents the reabsorption of water in the tubules), thereby facilitating the excretion of poisons, toxins and metabolic products.The pronounced vollemic effect positively affects hemodynamics and is simultaneously accompanied by the washing out of metabolic products from the tissues, which together with an increase in diuresis provides an accelerated detoxification of the organism. Each gram of dextran contributes to the redistribution of 20-25 ml of fluid from tissues into the bloodstream. It is pyrogen-free, non-toxic. It is especially indicated if the filtration capacity of the kidneys decreases or if the introduction of sodium chloride is necessary.

Pharmacokinetics:

Half-life is 6 hours. It is excreted by the kidneys, for 6 hours - 60% (up to 70% for the first day), a small part is excreted by the gastrointestinal tract during the day.

30% goes to the reticuloendothelial system, the liver, where the enzyme is digested with acidic alpha-glucosidase to glucose, but is not a source of carbohydrates.

Indications:

Resuscitation of patients with injuries, burns, after surgery.

Prevention of arterial hypotension in cesarean section.

To improve capillary blood flow and replenish the volume of circulating blood.

To improve capillary blood flow and replenish the volume of cirrhotic blood: paralytic intestinal obstruction, fat embolism; traumatic, burn,hemorrhagic, postoperative, cardiogenic and toxic shock (prevention and treatment). Substitution of plasma volume for blood loss in pediatrics. To improve arterial and venous circulation (prevention and treatment): thrombosis, thrombophlebitis, obliterating endarteritis, Raynaud's disease, threat of gangrene development, acute stroke.

For detoxification: peritonitis, pancreatitis, ulcerative-necrotic enterocolitis, food toxic infections, extensive purulent-necrotic processes of soft tissues, crash syndrome, "inclusion" syndrome.

For hemodilution in the preoperative period.

Conducting therapeutic plasmapheresis to replace the removed volume of plasma. Prevention of thrombosis on transplants (heart valves, vascular grafts); for addition to a perfusion solution in an apparatus of artificial circulation in open heart operations.

Disorders of microcirculation: traumatic or idiopathic hearing loss.

Diseases of the retina and optic nerve (complicated high degree myopathy, mesh sheath dystrophy, retinal vascular (venous) pathology, initial atrophy), inflammatory diseases of the cornea and the choroid of the eye.

ICD-10

I.A00-A09.A05.9 Bacterial food poisoning, unspecified

I.A30-A49.A48.3 Toxic shock syndrome

IV.E70-E90.E86 Reduction of the volume of the liquid

VII.H15-H22.H16.9 Keratitis, unspecified

VII.H30-H36.H31.9 Vascular disease, unspecified

VII.H30-H36.H35.3 Degeneration of the macula and posterior pole

VII.H30-H36.H35.8 Other specified retinal disorders

VII.H46-H48.H46 Optic neuritis

VIII.H90-H95.H91 Other hearing loss

IX.I60-I69.I63 Cerebral infarction

IX.I70-I79.I73.0 Raynaud's syndrome

IX.I70-I79.I73.8 Other specified diseases of peripheral vessels

IX.I70-I79.I74.9 Embolism and thrombosis of unspecified arteries

IX.I80-I89.I80 Phlebitis and thrombophlebitis

IX.I80-I89.I82.9 Embolism and thrombosis of unspecified vein

XI.K50-K52.K51.0 Ulcerative (chronic) enterocolitis

XI.K55-K63.K56.0 Paralytic ileus

XI.K65-K67.K65 Peritonitis

XI.K80-K87.K85 Acute pancreatitis

XVIII.R50-R69.R57 Shock, not elsewhere classified

XVIII.R50-R69.R57.0 Cardiogenic shock

XVIII.R50-R69.R57.1 Hypovolemic shock

XVIII.R50-R69.R57.8 Other types of shock

XVIII.R50-R69.R58 Bleeding, not elsewhere classified

XIX.T36-T50 Poisoning with medicines, medicines and biological substances

XIX.T79.T79.1 Fat embolism (traumatic)

XIX.T79.T79.3 Post-traumatic wound infection, not elsewhere classified

XIX.T79.T79.4 Traumatic shock

XIX.T80-T88.T81.1 Shock during or after the procedure,not classified elsewhere

Contraindications:

Thrombocytopenia, hemorrhage, hypersensitivity, chronic kidney disease (oliguria and anuria), decompensated chronic heart failure (danger of developing pulmonary edema). Trauma to the skull with increased intracranial pressure, cerebral hemorrhage and other cases where the introduction of large amounts of fluid is not indicated. In ophthalmic practice: electrophoresis is contraindicated in the maceration of the skin of the eyelids. Diabetes mellitus and other disorders of carbohydrate metabolism.

Carefully:

At the first administration, it is necessary to monitor the patient's condition in order to avoid an allergic reaction.

Pregnancy and lactation:

Category Food and Drug Administration (US Food and Drug Administration) not determined.

Dosing and Administration:

Intravenously jet, drip-drop and drip, as well as by electrophoresis (in ophthalmology).

The dosage regimen is individual, determined by the patient's condition, the amount blood pressure, heart rate, hematocrit indicators.

When applying the drug, a bioassay is mandatory: after a slow injection of the first 5 drops, stop the transfusion for 3 minutes, then inject another 30 drops and stop the infusion for 3 minutes. In the absence of a reaction, the administration continues. The results of the bioassay are necessarily recorded in the medical history.

When there is a violation of capillary blood flow (various forms of shock) intravenously drip or drip-drop injected at a dose of 0.5 to 1.5 liters to stabilize hemodynamic parameters at the life-supporting level. If necessary, the volume of the drug can be increased to 2 liters.

When cardiovascular and plastic surgery is introduced intravenously drip, immediately before surgery, for 30-60 minutes to adults and children at a dose of 10 ml / kg; during surgery, adults - 500 ml, children - 1.5 ml / kg. After the operation, the drug is administered intravenously drip (within 60 minutes) for 5-6 days from the calculation: adults - 10 ml / kg, children up to 2-3 years - 10 ml / kg 1 time per day, children under 8 years - 7-10 ml / kg 1-2 times a day, children under 13 years - 5-7 ml / kg 1-2 times a day; for children over 14 years of age, the doses are the same as for adults.

In operations with artificial circulation, the drug is added to the blood at a rate of 10-20 ml / kg to fill the oxygenator pump.The concentration of dextran in the perfusion solution should not exceed 3%. In the postoperative period, the doses of the drug are the same as for a violation of capillary blood flow.

For the purpose of detoxification, intravenously drip in a single dose of 500 to 1250 ml (in children 5-10 ml / kg) for 60-90 minutes. If necessary, you can pour another 500 ml of the drug in the first day (in children the administration of the drug in the first day can be repeated in the same doses). In the following days, the drug is administered drip, adults in a daily dose of 500 ml, children - at a rate of 5-10 ml / kg. It is jointly advisable to introduce crystalloid solutions (Ringer, Ringer-acetate, etc.) in such quantities as to normalize the water-electrolyte balance (especially important in the treatment of dehydrated patients and after surgical operations); the drug, as a rule, causes an increase in diuresis (a decrease in diuresis indicates dehydration of the body).

In ophthalmic practice, it is used by electrophoresis, which is carried out in a conventional way. The consumption of the drug per 1 procedure is 10 ml. The procedure is carried out once a day, injected both from the positive and from the negative pole. Current density - up to 1.5 mA / cm². The duration of the procedure is 15-20 minutes. The course of treatment - 5-10 procedures.

Side effects:

Allergic reactions (skin rash, possible anaphylactic reactions with the development of collapse, oliguria), fever, chills, fever, nausea. Can provoke bleeding, the development of acute renal failure. Arterial hypotension.

Overdose:

Not described, treatment is symptomatic.

Interaction:

Pharmaceutical and / or pharmacodynamic incompatibility is possible when combined with other drugs, visual compatibility control is required. Pharmaceutical incompatibility can be associated with a weakly acidic medium of the drug.

Compatible with crystalloid solutions.

Special instructions:

It is necessary to monitor the hematocrit, not to let the hematocrit decrease by 25-30%. May interfere with the definition of the blood group.

Together with the preparation, it is advisable to administer crystalloid solutions (0.9% sodium chloride solution, 5% dextrose solution) in such quantity as to replenish and maintain the water-electrolyte balance. This is especially important in the treatment of dehydrated patients and after severe surgical operations.

It causes an increase in diuresis (if there is a decrease in diuresis with the release of viscous syrupy urine, this may indicate dehydration, in this case it is necessary to inject intravenously colloidal solutions to replenish and maintain the water-electrolyte balance). In patients with reduced filtration capacity of the kidneys, it is necessary to limit the administration of sodium chloride.

Dextrans are able to envelop the surface of red blood cells, preventing the determination of the blood group, so for analysis it is necessary to use washed red blood cells.

Instructions

Dextran (Dextranum)