Shock

Infusion technique- reactions that can occur because of the solution or the technique of admin.
include febrile response, infection at the injection site, venous thrombosis, or phlebitis extending
from injection site, extravasation and hypervolemia. If a reaction develops discontinue and treat
accordingly.

Hypersensitivity-  allergic reactions include urticaria, nasal congestion, and rarely anaphylactoid
(allergic) shock.

Miscellaneous-  sudden marked hypertension , nausea, vomiting, fever, joint pains

Hypernatremia may be associated with edema, and exacerbation of congestive heart failure due
 to water retention , resulting in expanded extracellular fluid volume.

Hypersensitivity to dextran

Special Precautions-
Fluid imbalance- fluid or solute overloading may occur resulting in dilution of serum electrolyte
concentration, overhydration, congested states CHF and peripheral edema. The risk of dilutional
states is inversely propotional to the electrolyte concentration of administered parentral solutions. 

Hematologic effects- in individuals with normal hemostasis dosages approximating 15ml/kg or
more than 1000ml prolong bleeding time and decrease coagulation due to depressed platelet
function.
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.
 
Special risk patients- use solutions containing sodium ions with great care, if at all in patients
with congestive heart failure , pulmonary edema, severe renal insufficiency , patients receiving
corticosteroids, and  in clinical states  in which edema exists with sodium retension.

Excercise care in patients with pathological abdominal conditions and in those undergoing
bowel surgery.

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

Hypersensitivity reactions- severe and fatal anaphylactoid reactions (eg. marked hypotension,
cardiac and respiratory arrest) have occurred  in early in the infusion period of patients not
previously exposed to IV dextran. Stop infusion  immediately if an anaphylactoid reaction is
imminent  

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

Lactation- excercise caution when administering  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.

Monitoring central venous blood pressure s recommended to detect overexpansion of blood volume
When signs of overexpansion appear, discontinuning IV infusion allows blood volume to readjust
and decline, primarily by loss of fluid to urine.

Indication-
Shock

Dosage-
Adults-
Administer IV infusion only. Total dose and rate of infusion depend upon the magnitude of fluid
loss and the resultant hemoconcentration. It is suggested that the total dosage not to exceed
20ml/kg during the first 24 hours.

Children-The best guide to dosage is the body weight or surface area of the patient, the total
dosage should not exceed 20ml/kg

Pharmacology-
Dextrans are synthetic ploysaccharides used to approximate the colloidal properties of albumin.

Dextran 70 has an average has a molecular weight of 70,000 (ranging 20,000 to 200,000 ) and
Dextran 75 has an average of 75,000.

Dextran 70 improves blood pressure, pulse rate, respiratory exchange and renal function in patients
with hypovolemia and hypotensive shock. 

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

Lactation-
Excercise caution when administering  to a nursing woman