Dextran + Sodium Chloride

Approved Indications:

• Plasma Volume Expansion: Treatment of hypovolemia due to hemorrhage, surgery, trauma, or burns where rapid plasma volume replacement is necessary.
• Shock Management: Used in hypovolemic shock to restore and maintain circulatory volume and improve tissue perfusion.
• Prevention of Blood Clot Formation: Due to dextran’s antithrombotic properties, sometimes used to reduce blood viscosity and prevent thrombosis in specific clinical scenarios.
• Fluid and Electrolyte Replacement: Sodium chloride provides electrolyte balance and helps restore plasma osmolality during fluid resuscitation.
• Maintenance of Blood Pressure: Supports hemodynamic stability in patients with low blood pressure secondary to volume loss.

Off-label or Clinically Accepted Uses:

• Carrier solution for intravenous administration of other drugs.
• Perioperative fluid management in select patients.
• Adjunct in treatment protocols for certain shock states.

Adults:

• Dosage individualized based on clinical condition and hemodynamic response.
• Initial infusion volume typically ranges from 500 mL to 2000 mL depending on severity of hypovolemia.
• Infusion rate generally started at 1–2 mL/kg/hour, titrated according to patient status and monitoring parameters.

Pediatrics:

• Dose calculated by weight and clinical need.
• Lower volumes and slower infusion rates recommended.
• Monitor fluid status carefully to avoid overload.

Elderly:

• Use lower infusion rates initially.
• Close monitoring of cardiac, renal, and fluid balance recommended.

Renal and Hepatic Impairment:

• Caution advised due to risk of fluid retention and altered metabolism.
• Monitor electrolytes and renal function closely.

Administration:

• Administer via intravenous route (central or peripheral vein).
• Use infusion pump for precise rate control.
• Monitor vital signs, urine output, and laboratory parameters during infusion.

Dextran is a branched polysaccharide that acts as a plasma volume expander by exerting oncotic pressure within the blood vessels, which draws water from the interstitial and intracellular compartments into the vascular space. This effect increases intravascular volume and improves circulation. Sodium chloride maintains extracellular fluid osmolality and electrolyte balance, essential for normal cellular function and effective volume expansion. Together, the combination restores blood volume, improves cardiac output, and enhances tissue perfusion in hypovolemic conditions.

• Absorption: Administered intravenously; immediate systemic availability.
• Distribution: Dextran remains primarily within the intravascular space for 12 to 24 hours depending on molecular weight; sodium chloride equilibrates rapidly across extracellular fluid.
• Metabolism: Dextran is metabolized slowly by dextranase enzymes into smaller glucose polymers; sodium chloride is not metabolized but distributed within extracellular fluid.
• Half-life: Dextran 40 has a plasma half-life of approximately 2–3 hours; dextran 70’s half-life is approximately 12–24 hours.
• Excretion: Dextran is primarily cleared by renal glomerular filtration; sodium chloride is excreted by kidneys maintaining electrolyte homeostasis.

• Pregnancy: No adequate controlled studies; use only if benefit justifies potential risk. Volume expansion may be necessary in pregnancy complications.
• Lactation: Minimal systemic absorption of dextran or sodium chloride affects breast milk; considered compatible but use with caution.

• Primary Class: Plasma volume expander and intravenous electrolyte solution.
• Subclass: Colloid (dextran) combined with crystalloid (sodium chloride).

• Known hypersensitivity to dextran, sodium chloride, or formulation excipients.
• Congestive heart failure or pulmonary edema.
• Severe renal impairment or anuria.
• Hypervolemia.
• Severe dehydration without prior volume resuscitation.
• Bleeding disorders without appropriate monitoring.

• Monitor for signs of fluid overload, especially in patients with cardiac or renal disease.
• Risk of anaphylaxis or hypersensitivity reactions to dextran; emergency resuscitation equipment should be available.
• Monitor coagulation status due to dextran’s antiplatelet effects.
• Electrolyte disturbances possible; monitor serum electrolytes regularly.
• Avoid rapid infusion to prevent pulmonary edema and cardiovascular strain.
• Use cautiously in elderly and critically ill patients.

Common:

• Transient hypotension.
• Nausea.
• Flushing.
• Headache.

Serious/Rare:

• Anaphylactic reactions.
• Pulmonary edema.
• Coagulopathy and bleeding tendency.
• Renal dysfunction.
• Electrolyte imbalances.

• May potentiate bleeding with anticoagulants and antiplatelet agents.
• Increased nephrotoxicity risk with concurrent nephrotoxic drugs.
• Electrolyte imbalance risk when combined with diuretics.
• Monitor glucose control in diabetic patients receiving sodium chloride-containing solutions.

• Current guidelines emphasize careful titration of infusion rate and volume based on hemodynamic monitoring.
• Enhanced monitoring of coagulation and renal function recommended during dextran therapy.
• Use of dextran solutions is generally reserved for specific clinical situations due to availability of alternative plasma expanders.
• Sodium chloride solutions continue as standard for fluid and electrolyte replacement, with adjustment per patient status.

• Store at controlled room temperature between 20°C and 30°C (68°F to 86°F).
• Protect from light, moisture, and extreme temperatures.
• Keep container tightly closed until use.
• Do not freeze.
• Use aseptic technique during preparation and administration.
• Discard unused portions per institutional protocol.