Adequate long-term data on the use of hydroxyethyl starch in patients who underwent surgery or trauma are not available. The expected benefit of treatment should be carefully correlated with uncertain long-term safety. Other available therapeutic measures should be considered.
In connection with the possibility of developing allergic reactions, introduce the first 10-20 ml of the solution should be done slowly (drip), carefully monitoring the patient's condition.
Treatment should be carried out under the control of ions, white blood cells, platelets. hemoglobin, indicators of blood clotting, kidney function.
When the first signs of kidney and coagulopathy manifestations are discontinued, the drug should not be discontinued.
For 90 days after the infusion of the drug it is necessary to monitor the kidney function.
At the beginning of therapy, it is required to monitor the serum levels of creatinine.
At the limit values of creatinine (1.2-2 mg / dL or 106-177 μmol / L - compensated renal failure), it is necessary to carefully weigh the possibility and necessity of therapy and be sure to carry outfrequent monitoring of fluid balance, as well as urinary retention rates.
It should be borne in mind that hydroxyethylated starch may affect clinical and chemical indices (glucose, protein, sedimentation rate of erythrocytes, fatty acid, cholesterol, sorbitol dehydrogenase, specific gravity of urine). The introduction of high doses of the drug leads to a decrease in hematocrit, hemoglobin concentration and plasma protein. The values of hemoglobin below 10% and hematocrit below 27% are considered critical.
Starting with a total protein of less than 5 g / dl, administration of albumin is indicated. When blood loss exceeds 20-25% of the circulating blood volume, addition of the erythrocyte mass is also shown.
During treatment, it is necessary to ensure a sufficient supply of fluid in the body.
When anaphylactoid reactions occur, the drug should be discontinued, the patient should be transferred to the "lying" position with the head lowered, the airway released; then intravenously administered
epinephrine, previously diluted 1 ml of the solution (1: 1 thousand) to 10 ml - first slowly injected 1 ml of the resulting solution (0.1 mg).while controlling the pulse and blood pressure; the introduction of einephrine can be repeated. Then 5% solution of human albumin is prescribed intravenously (to replenish the volume of circulating blood), glucocorticosteroids (GCS) (250-1000 ml of 11 rendinolone), and anti-opiate drugs.
In the treatment of patients whose blood group is not established, it must be borne in mind that the introduction of large volumes of hydroxyethylironapic starch may make it difficult to interpret the results of the agglutination reaction.
After intravenous administration of the drug, the activity of amylase in the blood increases markedly, which returns to the norm after 3-5 days (it may interfere with the laboratory diagnosis of pancreatitis without affecting the clinical picture).
The drug does not affect the definition of the blood group.
Non-wetting of the inner surface of the bottle or container is not a contraindication to the use of the drug. The presence of moisture in the secondary bag with the container is allowed provided the container is hermetically sealed.