DEXTRAN 40

DEXTRAN 40
(dex'tran)
Gentran 40, 10% LMD, Rheomacrodex
Classifications: plasma volume expander;
Therapeutic: plasma volume expander

Prototype: Albumin
Pregnancy Category: C

Availability

10% solution in D5W or NS

Action

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.

Therapeutic Effect

Cardiovascular response to volume expansion includes increased BP, pulse pressure, CVP, cardiac output, venous return to heart, and urinary output.

Uses

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.

Contraindications

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.

Cautious Use

Active hemorrhage; severe dehydration; chronic liver disease; impaired renal function; thrombocytopenia; patients susceptible to pulmonary edema or CHF.

Route & Dosage

Shock
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 500–1000 mL (10 mL/kg) on the day of operation followed by 500 mL/d for 2–3 d, may continue with 500 mL q2–3d for up to 2 wk if necessary

Priming for Extracorporeal Circulation
Adult: IV 10–20 mL/kg added to perfusion circuit

Administration

Intravenous
  • 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., 20–40 mL/min); give remaining portion of the daily dose over 8–24 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).

Interactions

Drug: May potentiate abciximab anticoagulant effects.

Pharmacokinetics

Onset: 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.

Nursing Implications

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: 5–10 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 and chloride.
  • 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.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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