Infusionstherapie und klinische Ernährung
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Infusionsther Klin Ernahr · Apr 1980
[Pharmacokinetics of middle-molecular hydroxyethyl starch (HAS 200/0,5].
The pharmacokinetics of middle molecular weight hydroxyethyl starch (HES; MW 200,000, Mn: 35,000, MW/Mn = 5.71, MS = 0.50) were examined in two groups of normovalaemic subjects. Subjects in group 1 (non-fasted) were administered an approximately equal dose of HES, twice as rapidly as subjects in group 2 (fasted pre- and postinjection). The intravascular half-life (IT50) of HES in groups 1 and 2 was 2.7 +/- 1.3 and 3.9 +/- 1.1 (SD), respectively. 96 h post-injection, 2% of the initially measured HES 200/0.5 concentration remained in the serum of group 1 subjects. ⋯ Similar changes occurred in the molecular size distribution of HES polymers excreted in the urine of these subjects. The erythrocyte sedimentation rate was not significantly affected by the presence of large quantities of HES 200/0.5 in the blood. The results of this preliminary study in normal man has shown that HES 200/0.5 appears to be an ideal volemic colloid for clinical situations requiring restoration of a diminished plasma volume of short duration.
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Infusionsther Klin Ernahr · Jun 1979
[Intravascular persistence, tissue storage and excretion of hydroxyethyl starch (HAS)].
Hydroxyethyl starch is a derivative of amylopectin, the branched glycogen-like alpha-1,4-glucose polymer, the amylase hydrolysis of which is retarded by hydroxyethylation. If 70 to 90 per cent of the glucose polymer units contain hydroxyethyl groups, the intravascular persistence and urinary excretion of hydroxyethyl starch of a molecular weight of 435,000 is similar to that of Dextran 70. ⋯ Elimination of hydroxyethyl starch from sites of tissue storage is much faster than elimination of the non-metabolized polymers acacia and polyvinylpyrrolidone. The distribution and excretion kinetics of hydroxyethyl starch are thus appropriate for a plasma substitute.
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The lapse of coagulation disorders in polytraumatized patients is regarded as a substantial part of complications in the course of traumatic-hemorrhagic shock. In 71 polytraumatized patients blood-clotting tests were performed and showed that changes may already occur at a very early stage of the shock. The extent of these changes is closely related to the degree of the injury. It could be demonstrated that prompt shock-treatment and maintenance of adequate circulation as well as administration of low doses of heparin are important for spontaneous recompensation of the hemostatic defect.
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Infusionsther Klin Ernahr · Jun 1978
[Blood volume replacement and hemodilution with hydroxyethyl starch].
For high molecular hydroxyethylstarch (MW 450000, DS 0.7-0.8) an adequate volume effect has been demonstrated in numerous experimental and clinical studies; this colloid is, therefore, suitable for primary volume replacement as well as for preoperative normovolemic hemodilution. In contrast to colloids hitherto known HES infusion results in hyperamylasemia of probably non-pathogenic importance but significance for differential diagnosis in the post-operative period. Anaphylactoid reactions to HES are infrequent (0.08%). ⋯ The elimination of HES from the circulation follows a protracted course, therefore accumulation of HES in tissues may occur after repeated infusions presenting a clear disadvantage of HES. There is, however, evidence that starch-preparations will be available in the future presenting an adequate volume effect while the elimination from the organism occurs rapidly. Low molecular hydroxyethylstarch (HES 450000, DS 0.5-0.55) yields inadequate volume effects; for this, low molecular HES can neither be recommended for long-lasting volume replacement nor for preoperative hemodilution.
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Infusionsther Klin Ernahr · Apr 1978
[Comparative studies of the warming capacity of 2 blood warmers].
The warming effect of two apparatuses using dry heat and of one apparatus with blood warming by microwaves is measured at the entry of the blood into the venous circulation. The following facts were compared: the time needed to prepare the apparatus, any occuring technical hazards, the relationship between blood temperature and blood flow, and finally the economy of the equipment. The results show alternative indications, on one hand for the use of warmers with dry heat, on the other hand for those with microwaves. The low flows are of interest in the warming procedure of patients with hypothermia following trauma and the blood transfusion applied to infant anaesthesia.