| Clinical data | |
|---|---|
| Pregnancy cat. | ? |
| Legal status | ? |
| Routes | Intravenous |
| Pharmacokinetic data | |
| Half-life | 1.4 hrs |
| Excretion | Renal |
| Identifiers | |
| CAS number | 9005-27-0 |
| ATC code | B05AA07 |
| ChemSpider | 17340832 |
| UNII | 875Y4127EA |
| Chemical data | |
| Formula | ? |
| Mol. mass | 130 - 200 kDa (typical) |
| SMILES | eMolecules & PubChem |
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Hydroxyethyl starch (HES/HAES) is a nonionic starch derivative. It is one of the most frequently used volume expander under the trade names Hespan by B. Braun Medical Inc. and Voluven or Volulyte by Fresenius Kabi.
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An intravenous solution of hydroxyethyl starch is used to prevent shock following severe blood loss caused by trauma, surgery, or some other problem. It increases the blood volume, allowing red blood cells to continue to deliver oxygen to the body. During 2010/11 a large number of research papers associated with a single author were retracted for ethical reasons and this may have an impact on clinical guidelines referring to HES preparations prepared before this date.[1]
Different types of hydroxyethyl starches are typically described by their average molecular weight, typically around 130 to 200 kDa (bearing in mind that there will be a range of different-sized molecules in any given solution); and their degree of molar substitution (what proportion of the glucose units on the starch molecule have been replaced by hydroxyethyl units), typically around 0.35 to 0.5. A solution of hydroxyethyl starch may further be described by its concentration in % (i.e. grams per 100ml). So for example, one commercially available hydroxyethyl starch (Voluven) is described as 6% HES 130 / 0.4.
The elimination depends on molar substitution degree. Molecules smaller than the renal threshold (60–70 kDa) are readily excreted in the urine while the larger ones are metabolized by plasma α–amylase before the degradation products are renally excreted.
Anaphylactoid reactions: hypersensitivity, mild influenza-like symptoms, bradycardia, tachycardia, bronchospasm and non-cardiogenic pulmonary edema.
Decrease in hematocrit and disturbances in coagulation. One liter of 6% solution (Hespan) reduces factor VIII level by 50% and will prolong aPTT.[2]
May be associated with covering the use of anabolic steroids/EPO for endurance athletes.
HES derivatives with a higher molecular weight (200 kDa) have been demonstrated to have increased rates of acute renal failure and need for renal replacement therapy and to decrease long-term survival when used alone in cases of severe sepsis compared with Ringer Lactate solution (Brunkhorst 2008).[3] This study specifically used 10% HES with 0.45-0.55 substitution grade and molecular weight of 200 kDa (Hemohes). It also used a regimen without any crystalloids and was criticized for its study design.[4] The same effects have not been observed with HES 130kDa/0.4. It has been recommended that, since medium-MW HES solutions may be associated with harm, these solutions should not be used routinely for patients with septic shock.[5]