Gentran 40, 10% LMD, Rheomacrodex
Classifications: plasma volume expander; Therapeutic: plasma volume expander
Pregnancy Category: C
10% solution in D5W or NS
Low-molecular-weight polysaccharide. As a hypertonic colloidal solution, produces immediate and short-lived expansion of
plasma volume by increasing colloidal osmotic pressure and drawing fluid from interstitial to intravascular space.
Cardiovascular response to volume expansion includes increased BP, pulse pressure, CVP, cardiac output, venous return to
heart, and urinary output.
Adjunctively to expand plasma volume and provide fluid replacement in treatment of shock or impending shock. Also used in
prophylaxis and therapy of venous thrombosis and pulmonary embolism. Used as priming fluid or as additive to other primers
during extracorporeal circulation.
Hypersensitivity to dextrans, severe renal failure, hypervolemic conditions, severe CHF, significant anemia, hypofibrinogenemia
or other marked hemostatic defects including those caused by drugs, (e.g., heparin, warfarin); pregnancy (category C), lactation.
Active hemorrhage; severe dehydration; chronic liver disease; impaired renal function; thrombocytopenia; patients susceptible
to pulmonary edema or CHF.
Route & Dosage
Adult/Adolescent/Child: IV Up to 20 mL/kg in the first 24 h (doses up to 10 mL/kg/d may be given for a maximum of 4 additional days if needed)
Prophylaxis for Thromboembolic Complications
Adult: IV 5001000 mL (10 mL/kg) on the day of operation followed by 500 mL/d for 23 d, may continue with 500 mL q23d
for up to 2 wk if necessary
Priming for Extracorporeal Circulation
Adult: IV 1020 mL/kg added to perfusion circuit
- If blood is to be administered, draw a cross-match specimen before dextran infusion.
PREPARE: IV Infusion: Use only if seal is intact, vacuum is detectable, and solution is absolutely clear.
ADMINISTER: IV Infusion: Specific flow rate should be prescribed by physician. For emergency treatment of shock in adults give first 500 mL rapidly
(e.g., 2040 mL/min); give remaining portion of the daily dose over 824 h or at the rate prescribed.
INCOMPATIBILITIES Solution/additive: Amoxicillin, ampicillin, oxacillin, penicillin.
- Store at a constant temperature, preferably 25° C (77° F). Once opened, discard unused portion because dextran
contains no preservative.
Adverse Effects (≥1%)Body as a Whole:
Hypersensitivity (mild to generalized urticaria, pruritus, anaphylactic shock
(rare), angioedema, dyspnea
). Other: Renal
tubular vacuolization (osmotic nephrosis), stasis, and blocking; oliguria, renal failure
; increased AST and ALT, interference with platelet function, prolonged bleeding and coagulation times.
Diagnostic Test Interference
When blood samples are drawn for study, notify laboratory that patient has received dextran. Blood glucose: false increases (utilizing ortho-toluidine methods or sulfuric or acetic acid hydrolysis). Urinary protein: false increases (utilizing Lowry method). Bilirubin assays: false increases when alcohol is used. Total protein assays: false increases using biuret reagent. Rh testing, blood typing and cross-matching procedures: dextran may interfere with results (by inducing rouleaux formation) when proteolytic enzyme techniques are used (saline agglutination and indirect antiglobulin methods reportedly not affected).
May potentiate abciximab
Volume expansion within minutes of infusion. Duration:
12 h. Metabolism:
Degraded to glucose and metabolized to CO2
and water over a period of a few weeks. Elimination:
75% excreted in urine within 24 h; small amount excreted in feces.
Assessment & Drug Effects
- Evaluate patient's state of hydration before dextran therapy begins. Administration to severely dehydrated patients can
result in renal failure.
- Lab tests: Baseline Hct prior to and after initiation of dextran (dextran usually lowers Hct). Notify physician if Hct is
depressed below 30% by volume.
- Monitor vital signs and observe patient closely for at least the first 30 min of infusion. Hypersensitivity reaction is
most likely to occur during the first few minutes of administration. Terminate therapy at the first sign of a hypersensitivity
reaction (see Appendix F).
- Monitor CVP as an estimate of blood volume status and a guide for determining dosage. Normal CVP: 510 cm H2O.
- Observe for S&S of circulatory overload (see Appendix F).
- Note: When sodium restriction is indicated, know that 500 mL of dextran 40 in 0.9% normal saline contains 77 mEq of both sodium
- Monitor I&O ratio and check urine specific gravity at regular intervals. Low urine specific gravity may signify failure
of renal dextran clearance and is an indication to discontinue therapy.
- Report oliguria, anuria, or lack of improvement in urinary output (dextran usually causes an increase in urinary output).
Discontinue dextran at first sign of renal dysfunction.
- High doses are associated with transient prolongation of bleeding time and interference with normal blood coagulation.
Patient & Family Education
- Report immediately S&S of bleeding: easy bruising, blood in urine or dark tarry stool.