Treatment should be controlled to ensure adequate rehydration of patients (at least 2-3 liters of fluid per day), bcc, electrolytes, leukocytes, platelets, hemoglobin, blood coagulation, kidney function.
It should be borne in mind that HES can affect laboratory indicators (glucose, protein, erythrocyte sedimentation rate (ESR), fatty acids, cholesterol, sorbitol dehydrogenase, specific gravity of urine).
After intravenous administration of the drug, the activity of amylase in the blood increases, which returns to the norm in 3-5 days (it may interfere with the laboratory diagnosis of pancreatin without affecting the clinical picture).
Volekam does not affect the definition of the blood group.
The introduction of high doses of the drug leads to a decrease in hematocrit, hemoglobin concentration and plasma protein. The hemoglobin value below 10 g% and the hematocrit below 30% are considered critical. Starting with a total protein of less than 5 g / dL, the administration of albumin is indicated. With blood loss above 20-25% BCC, additional administration of erythrocyte mass is indicated.
If there is a lack of fibrinogen, the drug can be used only in case of emergency care, when the life of the patient is at risk in the absence of components of the donor blood.
In connection with the possibility of developing allergic reactions after the introduction of the first 5-10 and the subsequent 30 drops, a break for 3 minutes is necessary,To determine the tolerability of the drug to the patient. Symptoms of anaphylaxis may appear within a few minutes. Symptoms that cause anxiety are severe itching and redness of the skin (a sudden rush of blood to the face, neck). Sometimes the patient suffers suffocation, there is a feeling of "coma in the throat". Characteristic for the next stage are nausea and cramps in the abdomen, as well as tachycardia and arterial hypotension, which can lead to loss of consciousness, up to the stopping of breathing and the cessation of cardiac activity.
In case of intolerance reactions, the drug should be stopped immediately and the necessary emergency measures taken.
Emergency measures of help in case of reaction of intolerance:
Stop the infusion, leave the cannula in the vein.
1. Skin reactions: Antihistamines.
2. Tachycardia, a drop in blood pressure, nausea, vomiting: Antihistamines and glucocorticosteroids (100 mg of prednisolone intravenously).
3.
Shock, bronchospasm: Epinephrine (epinephrine) 0.05-0.1 mg slowly intravenously.
4. Heart and / or respiratory arrest: Carrying out resuscitation measures taken in such cases.
Patients should be under continuous medical supervision, additional therapeutic measures should be applied depending on the condition of the patients.
The literature describes the relationship between the dose and frequency of itching in otoneurological diseases, such as sudden hearing loss, the appearance of tinnitus. With these diseases to reduce the incidence of itching is recommended to reduce the dose Volekam to 250 ml / day.
At the beginning of therapy, it is required to monitor the serum levels of creatinine. With limiting values of creatinine (1.2-2 mg / dL, or 106-177 μmol / L - compensated renal failure), it is necessary to correlate the possibility and necessity of the therapy and carefully monitor the water-electrolyte balance.
When the first signs of impairment on the part of the kidneys appear, the drug should be discontinued. It is recommended to monitor the condition of the kidneys for at least 90 days after using the drug Volekam.
In the treatment of patients with hypovolemia, severe hemodilution should be avoided.In case of repeated use, the parameters of blood coagulability should be carefully monitored. At the first signs of coagulopathy, the drug should be discontinued.
Adequate long-term data on the use of the drug Volekam in patients who have undergone surgical intervention or were injured are absent. The expected benefit of treatment should be carefully correlated with uncertain long-term safety. Other available therapeutic measures should be considered.
Due to the limited data on the use of Volekam in children, its use in this category of patients is not recommended.