Dextran + Dextrose

Approved Indications:

• Plasma Volume Expansion: Used to restore and maintain circulating blood volume in patients experiencing hypovolemia due to trauma, surgery, or hemorrhage.
• Hypotensive States and Shock: Employed in management of hypovolemic shock to improve hemodynamic stability.
• Prevention of Thrombosis: Dextran’s antithrombotic properties aid in reducing blood viscosity and preventing microthrombi formation in some clinical scenarios.
• Correction of Hypoglycemia: Dextrose component provides glucose for energy, aiding in treatment of hypoglycemia.
• Parenteral Nutrition and Hydration: Provides calories and fluid for patients requiring intravenous fluid replacement.

Off-label Uses:

• Used as a carrier solution for intravenous drugs.
• Adjunct in some surgical and intensive care protocols for volume maintenance and metabolic support.

Adults:

• Dose is individualized based on patient condition, volume status, and clinical response.
• Typical dose range: 500 mL to 2000 mL per day, infused intravenously.
• Infusion rates generally start at 1–2 mL/kg/hour and adjusted according to hemodynamic monitoring.

Pediatrics:

• Dose calculated according to weight and clinical status.
• Lower total volumes and slower infusion rates are recommended.
• Careful monitoring to avoid fluid overload.

Elderly:

• Initiate with lower infusion rates.
• Monitor cardiac, renal, and fluid status closely.

Special Populations:

• Renal or hepatic impairment: Use cautiously, monitor fluid balance and metabolic status.

Administration:

• Administer intravenously, via central or peripheral vein.
• Use infusion pump for precise control.
• Monitor vital signs, fluid balance, and blood glucose during therapy.

Dextran is a high molecular weight polysaccharide that acts as a colloid plasma volume expander by increasing oncotic pressure within the vascular compartment. This osmotic effect draws fluid from the interstitial and intracellular spaces into the bloodstream, thereby increasing circulating volume and improving tissue perfusion. Dextrose, a simple sugar, serves as an immediate energy source and supplies free water, supporting cellular metabolism and hydration. The combined action restores hemodynamic stability and provides metabolic fuel in hypovolemic and hypoglycemic states.

• Absorption: Administered intravenously; immediate systemic availability.
• Distribution: Dextran remains mainly intravascular for 12–24 hours depending on molecular weight; dextrose rapidly distributes to extracellular and intracellular compartments.
• Metabolism: Dextran metabolized by dextranase enzymes to smaller glucose polymers; dextrose metabolized by cellular glycolysis.
• Half-life: Dextran 40: approx. 2–3 hours; Dextran 70: approx. 12–24 hours.
• Excretion: Dextran eliminated primarily via renal filtration; dextrose metabolized into CO₂ and water.

• Pregnancy: No adequate controlled human studies. Use only if clearly indicated, considering potential fluid overload or metabolic risks.
• Lactation: Minimal secretion into breast milk expected; considered compatible with breastfeeding but monitor infant if large or repeated doses are administered.

• Primary Class: Plasma volume expander and intravenous carbohydrate solution
• Subclass: Colloid solution (dextran) combined with carbohydrate (dextrose)

• Hypersensitivity to dextran, dextrose, or excipients.
• Severe dehydration without adequate volume replacement.
• Congestive heart failure or pulmonary edema.
• Renal failure with oliguria/anuria.
• Hypervolemia.
• Known bleeding disorders without appropriate monitoring.
• Hyperglycemia or diabetic ketoacidosis (dextrose contraindicated).

• Risk of fluid overload especially in cardiac, renal, or pulmonary disease.
• Monitor for signs of anaphylaxis; dextran can cause severe hypersensitivity.
• Coagulation abnormalities possible; monitor bleeding parameters.
• Careful glucose monitoring necessary in diabetics.
• Avoid rapid infusion to prevent pulmonary edema and cardiovascular strain.

Common:

• Hypotension (transient)
• Nausea
• Flushing
• Headache

Serious/Rare:

• Anaphylactic reactions
• Pulmonary edema
• Coagulopathy and bleeding
• Renal impairment
• Hyperglycemia (due to dextrose)

• Increased bleeding risk with anticoagulants.
• Enhanced nephrotoxicity risk with nephrotoxic drugs.
• Dextrose may interfere with antidiabetic agents, reducing efficacy.
• Combined use with other colloids requires caution due to volume overload risk.

• Use guided by patient hemodynamic monitoring; infusion rates and total volumes adjusted accordingly.
• Emphasis on monitoring coagulation status and renal function during dextran therapy.
• Dextrose-containing fluids remain essential in managing hypoglycemia and providing caloric support.
• Caution in populations at risk of fluid overload; newer plasma expanders sometimes preferred.

• Store between 20°C and 30°C (68°F to 86°F).
• Protect from light and excessive heat.
• Keep container sealed until use.
• Do not freeze.
• Use aseptic technique when preparing and administering.
• Discard unused solution after recommended time.