Hydroxyethyl Starch + Sodium Chloride

• Approved Indications
• Volume Expansion and Plasma Replacement
• Management of hypovolemia due to blood loss or fluid shifts
• Supportive therapy in surgical procedures or trauma where rapid plasma volume replacement is needed
• Prevention of Shock
• Maintenance of circulatory volume in critically ill patients
• Management of hypotension secondary to fluid loss
• Off-label / Clinically Accepted Uses
• As a component of perioperative fluid management in select surgical procedures
• Adjunct in hemodynamic stabilization in patients with sepsis or burns (used cautiously)

• Adults
• Initial dose: 500 mL to 1000 mL intravenously over 15–30 minutes, depending on clinical status
• Maintenance dose: 500 mL every 6–12 hours or as needed based on hemodynamic response
• Elderly
• Start with lower volumes due to risk of volume overload and impaired renal function
• Pediatrics
• Use cautiously; dosing based on body weight (approx. 10–20 mL/kg over 30 minutes)
• Special Populations
• Renal impairment: Use with caution; monitor fluid balance and kidney function
• Hepatic impairment: Dose adjustments usually unnecessary but monitor hemodynamics
• Administration Route
• Intravenous infusion only
• Duration
• Use the minimum effective volume for the shortest duration to avoid complications

Hydroxyethyl starch (HES) is a colloid osmotic agent that increases plasma oncotic pressure, drawing water from the interstitial and intracellular spaces into the intravascular compartment. Sodium chloride contributes to isotonicity, maintaining electrolyte balance and preventing hypotonic shifts. Together, they expand circulating volume, improve cardiac output, enhance tissue perfusion, and stabilize hemodynamics during acute fluid loss.

• Absorption: Immediate intravascular availability via IV administration
• Distribution: Confined largely to the plasma compartment; small distribution to interstitial space over time
• Metabolism: Hydrolyzed by plasma and tissue amylases to smaller fragments
• Excretion: Renal elimination of starch fragments; Sodium chloride excreted via kidneys
• Onset: Within minutes post-infusion
• Half-life: 12–24 hours for plasma HES molecules, depending on molecular weight and degree of substitution
• Active Metabolites: Hydroxyethyl starch fragments after enzymatic breakdown

• Pregnancy: Category C (animal studies show adverse effects; human data limited). Use only if clearly needed, under strict monitoring
• Lactation: No data; negligible systemic absorption into breast milk expected; use with caution
• Caution: Monitor maternal hemodynamics and fluid status closely

• Primary Class: Plasma volume expander / Colloid solution
• Subclass: Hydroxyethyl starch-based colloid

• Known hypersensitivity to hydroxyethyl starch or sodium chloride
• Severe bleeding disorders or coagulopathy
• Severe renal insufficiency or risk of renal failure
• Uncontrolled heart failure or pulmonary edema
• Patients with hypervolemia

• High-risk patient groups: Critically ill, elderly, renal impairment, sepsis
• Serious risks:
• Risk of renal injury, especially with high doses or preexisting kidney disease
• Coagulopathy with repeated or high-volume administration
• Anaphylactic reactions possible
• Clinical monitoring:
• Monitor blood pressure, urine output, serum electrolytes, coagulation parameters
• Observe for pulmonary edema or fluid overload
• Early signs of severe adverse events: Reduced urine output, rising serum creatinine, hypotension, allergic reaction

• Common: Mild transient hypotension, headache, nausea
• Ocular / Dermatologic: Rare skin rashes, pruritus
• Serious / Rare:
• Acute renal failure
• Coagulation abnormalities (prolonged clotting time, platelet dysfunction)
• Anaphylactic or hypersensitivity reactions
• Timing: Usually within hours to days post-infusion; dose-dependent risk

• Anticoagulants (Heparin, Warfarin): Increased risk of bleeding due to coagulopathy
• Other colloids or crystalloids: Monitor cumulative fluid balance
• No major CYP450 involvement as metabolism is enzymatic and renal
• Drug-food / alcohol: Not applicable

• FDA / EMA Warnings: Emphasize restricted use in critically ill patients, especially with sepsis or renal risk
• Guideline Changes: Avoid HES in severe sepsis due to renal risk; prefer crystalloids in high-risk patients
• Monitoring recommendations: Strict fluid balance, renal function, and coagulation status during and after infusion

• Store at 20°C to 30°C (room temperature)
• Protect from light and freezing
• Do not use if solution is discolored, cloudy, or contains particles
• Do not mix with other medications unless compatibility is confirmed
• Use single-use vials or bags; discard unused portion after administration