HETASTARCH 
Pronounciation
- (HET-ah-starch)
Trade Name(s)
- Hespan, Hextend
Variable. Total dosage and rate of administration depend on amount of fluid loss and resultant hemoconcentration. Age, weight, and clinical condition of the patient are also considered. Usually 500 to 1,000 mL. Total dose usually does not exceed 1,500 mL/24 hr for the typical 70-kg patient (approximately 20 mL/kg of body weight). Higher doses, usually in conjunction with blood and/or blood products, have been used in postoperative and trauma patients who have had severe blood loss.
250 to 700 mL with citrate anticoagulant in continuous flow centrifugation procedures. Do not use Hextend for leukapheresis.
Avoid use in patients with pre-existing renal impairment. Information on dose adjustment in hepatic impairment is not available.
Available as a 6% solution in 500-mL containers properly diluted in NS and ready for use. Calculated osmolarity is approximately 310 mOsm/L.
Available as a 6% solution in 500-mL containers properly diluted in lactated electrolyte solution and ready for use. Lactated electrolyte solution contains dextrose, normal physiologic levels of calcium and sodium, and slightly lower than normal physiologic levels of potassium and magnesium.
Store at CRT. Avoid excessive heat. Do not freeze. Do not use if color is a turbid deep brown or a crystalline precipitate is visible. Discard unused portions.
Compatibility information not available from manufacturer. Other sources suggest a few specific compatibilities dependent on concentration and manufacturer; consult a pharmacist.
Safety and compatibility of other additives not established. Contains calcium; do not administer simultaneously through the same administration set as blood; coagulation likely.
Other sources suggest specific compatibilities dependent on concentration and manufacturer; consult a pharmacist.
Variable, depending on indication, present blood volume, and patient response. Initial 500 mL may be given at rates approaching 20 mL/kg of body weight per hour. If additional hydroxyethyl starch is required, reduce flow to lowest rate possible to maintain hemodynamic status. If pressure infusion is used (flexible containers), withdraw all air through medication port before infusing. If a pumping device is used for administration, discontinue pumping action before the container runs dry or air embolism may result.
Usually infused at a constant ratio to venous whole blood (i.e., 1:8).
A synthetic colloid solution. Pharmacologically classified as a plasma volume expander. The amount of plasma volume expansion produced approximates that of 5% albumin and decreases over the succeeding 24 to 36 hours. Hextend supports oncotic pressure and provides electrolytes. Its electrolyte content resembles that of normal plasma. Hespan supports oncotic pressure and increases erythrocyte sedimentation rate. Improves the efficiency of granulocyte collection by centrifugal means. Hetastarch molecules are rapidly eliminated by renal excretion.
Treatment of hypovolemia when plasma volume expansion is desired.
Adjunct in leukapheresis to improve harvesting and increase yield of granulocytes.
Do not use in critically ill adult patients, including patients with sepsis.
■ Severe liver disease.
■ Hypersensitivity to hetastarch.
■ Clinical conditions in which volume overload is a potential problem (such as CHF or renal disease with oliguria or anuria not related to hypovolemia).
■ Pre-existing coagulation or bleeding disorders.
■ Hextend contains lactate; not for use in leukapheresis or in the treatment of lactic acidosis.
For IV infusion only.
■ Not a substitute for whole blood or plasma proteins.
■ In critically ill adult patients, including patients with sepsis, the use of hydroxyethyl starch (HES) products, including Hespan and Hextend, increases the risk of mortality and renal replacement therapy.
■ Avoid use in patients with pre-existing renal dysfunction.
■ Discontinue use at the first sign of renal injury.
■ Use caution in heart disease, congestive heart failure, pulmonary edema, and liver disease.
■ Anaphylactic reactions have occurred, even after solutions containing hetastarch have been discontinued. Patients allergic to corn may also be allergic to hetastarch.
■ Administration of large volumes may transiently alter the coagulation mechanism due to hemodilution and a mild direct inhibitory action on factor VIII. Hemodilution by isotonic solutions containing 6% hetastarch may also result in a 24-hour decline of total protein, albumin, and fibrinogen levels and in transient prolongation of prothrombin, activated partial thromboplastin, clotting, and bleeding times. Volumes greater than 25% of blood volume within 24 hours may cause significant hemodilution (decreased hematocrit and plasma proteins). Administration of packed RBCs, platelets, or fresh frozen plasma may be indicated.
■ When used over a period of days, hetastarch has been associated with coagulation abnormalities in conjunction with an acquired reversible von Willebrand’s–like syndrome and/or factor VIII deficiency. If a severe factor VIII deficiency is identified, replacement therapy may be indicated. If coagulopathy develops, it may take days to resolve.
■ Not recommended for use as a cardiac bypass pump prime, while the patient is undergoing cardiopulmonary bypass, or in the immediate period after the pump has been discontinued. Risk of coagulopathies and bleeding increased.
Use extreme caution in patients with metabolic or respiratory alkalosis; contains lactate ions. Excessive lactate may result in metabolic alkalosis.
■ Contains electrolytes; use caution in patient populations in which sodium or potassium administration or retention could pose a problem (e.g., renal insufficiency, CHF, hyperkalemia, edema). Use caution in patients receiving corticosteroids and in renal or cardiac disease, particularly in digitalized patients.
■ Contains dextrose; use caution in patients with overt diabetes.
Monitor vital signs, hemoglobin, hematocrit, platelet count, prothrombin time, partial thromboplastin time, and renal and liver function tests.
■ Acid-base balance, electrolytes, and serum protein evaluation are also necessary during therapy.
■ Monitor renal function in hospitalized patients for at least 90 days because the use of renal replacement therapy has been reported up to 90 days after administration of hydroxyethyl starch solutions.
■ May reduce coagulability of the circulating blood. Observe patient for increased bleeding and/or circulatory overload. Risk increased with higher doses.
Monitor donors undergoing repeated leukapheresis procedures; may have a slight decline in platelet count and hemoglobin levels resulting from hemodilution by hetastarch and saline and the collection of platelets and erythrocytes. Temporary declines in total protein, albumin, calcium, and fibrinogen may also be present. Regular and frequent clinical evaluation and complete blood counts are necessary for proper monitoring of Hespan use during leukapheresis. If frequency of leukapheresis is to exceed the guidelines for whole blood donation, additional testing may be indicated; see manufacturer’s prescribing information.
Category C: embryocidal to rabbits. Use only if benefit justifies the potential risk to the fetus.
■ Use caution during breast-feeding.
■ Safety and effectiveness for use in pediatric patients not established, but has been used. Increased prothrombin time noted in pediatric patients who received more than 20 mL/kg/24 hr.
Differences in response between elderly and younger patients not identified. Risk of toxic reactions may be greater in patients with impaired renal function. Monitoring of renal function suggested in the elderly.
Use with caution in patients receiving other drugs that affect coagulation (e.g., anticoagulants, platelet aggregation inhibitors, glycoprotein GP IIb/IIIa receptor antagonists, plicamycin, valproic acid). Close monitoring of aPTT and PT indicated.
■ May increase indirect bilirubin levels. Total bilirubin remained normal.
■ Elevated serum amylase levels have been observed, although no association with pancreatitis has been demonstrated.
The most common adverse reactions are circulatory overload, coagulopathy, hemodilution, hypersensitivity (including anaphylaxis), and metabolic acidosis. Anemia and/or bleeding due to hemodilution and/or factor VIII deficiency, acquired von Willebrand’s–like syndrome, and other coagulopathies, including DIC; chills; congestive heart failure; elevated serum amylase; fever; headache; increased urine specific gravity; intracranial bleeding; itching; muscle pains; peripheral edema; pulmonary edema; submaxillary and parotid glandular enlargement; urticaria; and vomiting have been reported.
Death, renal failure requiring renal replacement therapy.
Notify the physician of any side effect. Discontinue the drug immediately at the first sign of a hypersensitivity reaction, provided other means of sustaining the circulation are available. Antihistamines such as diphenhydramine are helpful. Epinephrine may also be indicated. Not eliminated by dialysis. Many side effects can result in medical emergencies. Deaths from severe hypersensitivity reactions have occurred. Treat as indicated and resuscitate as necessary.