Shock

Hypersensitivity- mild cutaneous eruptions , generalized urticaria, hypotension, nausea,
vomiting, headache, dyspepsia, fever, tightness of the chest, bronchospasm, wheezing
and rarely anaphylactoid ( allergic  shock )

Miscellaneous-  reactions may occur because of the solution or the technique of administration,
include febrile respone , infection at the injection site, extravasation and hypervolemia

Hypernatremia may be associated with edema and excacerbation of congestive heart failure due to
the retension of water  resulting from expanded  cellular fluid volume.

If solutions containing  sodium chloride are infused in large volume, chloride ions may cause a loss
of bicarbonate ions, resulting in acidifying effect
 

Hypersensitivity to dextran

Special Precautions-
Fluid imbalance- these products are colloid hypertonic solutions and will attract water from
extravascular space. Poorly hydrated patients will need additional fluid therapy. If given in excess
vascular overload could occur. This can be avoided by minotoring central venous pressure.

Admin of dextran IV can cause fluid or solute overloading , resulting in dilution of serum electrolyte
concentrations, overhydration, congested states of pulmonary edema

Hemorrhage- use with patients with active hemorrhage,the increase in perfusion pressure and
improved microcirculaory flow result in additional blood loss.

Avoid administering the infusion beyond the recommended dose as dose related increase of
wound hematoma , wound serotoma, wound bleeding , distant bleeding ( hematuria and melena )
and pulmonary edema has been observed

Hematologic effects- use  in patients with thrombocytopenia. Hemotocrit should not be
depressed below 30% by volume. When large volumes of dextran are administered , plasma
protein levels will be decreased.
 Do not give dextran 40 to patients with marked thrombopenia or hypfubrinogenemia

Special risk patients- use solutions containing sodium ions with great care, if at all in patients
with congestive heart failure , severe renal insufficiency, in clinical states  in which edema exists with
sodium retension ( particularly in  postoperative or elderly patients and in patients receiving
corticosteroids.

Bleeding complications- observe patients for early signs of bleeding complications particulary
following surgery, major trauma or if anticoagulant drugs are being administered

Hypersensitivity reactions- antigenecity to dextrans is directly related to the degree of branching.
Hypersensitivity reactions reported ( see adverse reactions)

Renal function impairment- in patients with diminished renal function use of sloutions containing
sodium ions may result in sodium retention. Excessive doses may precipitate renal failure

Pregnancy- use only when clearly needed and when the potential  benefits outweigh the potential
hazards to the fetus.

Lactation- excercise caution when dextran 40 is administered  to a nursing woman

Monitoring- urine output  should be carefully monitored. Usually an increase in urine  output occurs,
in oliguric  patients after administration. If no increase is observed after infusion of 500ml discontinue
the drug until adequate diuresis develops spontaneously or can be induced by other means.

Excercise caution to prevent a depression of the hemotoceit below 30%

Indication-
Shock

Dosage-
The total dosage during the for the first  24 hours should not exceed 20mL/kg.
The first 10ml/kg should be infused rapidly  with the remaining dose being administered more slowly

Monitor the central venous pressure frequently during the initial infusion.

Should the therapy continue beyond 24 hours total daily dosage should not exceed 10ml/kg and the
therapy should not continue beyond 5 days.

Pharmacology-
Dextran 40 is a brached polysaccharide plasma volume expander with an average molecular weight
of 40,000 ( range 10,000 to 90,000 ) .

A 2.5% solution of dextran 40 is equivalent in colloid osmostic pressure to normal plasma.
Normally plasma, volume is increased onefold to twofold over the volume of dextran 40 infused

Pregnancy-
Use only when clearly needed and when the potential  benefits outweigh the potential
hazards to the fetus.

Lactation-
Excercise caution when dextran 40 is administered  to a nursing woman

Monitoring-
Urine output  should be carefully monitored. Usually an increase in urine  output occurs,
in oliguric  patients after administration. If no increase is observed after infusion of 500ml discontinue
the drug until adequate diuresis develops spontaneously or can be induced by other means.