Hecodez

Hecodez - a means of HES, which is a solution for perfusion and used as a blood substitute.

Indications of the gekodeza

It is used for hypovolemia, which is triggered by blood loss in acute form, but exclusively in situations where the use of only crystalloids has been found to be ineffective.

Release form

Release in the form of a solution for the preparation of medicinal infusions, in bottles with a volume of 200, 250, 400 or 500 ml, or in containers with a volume of 250 or 500 ml.

Pharmacodynamics

The HES element is formed from the substance amylopectin, and its parameters are determined by the substitution indices and the molecular weight. The average molecular weight of HES in Hecodez  is 200,000 Da, and the molar replacement expression is about 0.5. By its structure, this substance resembles glycogen, which explains the high rates of its tolerance, as well as the low probability of the appearance of anaphylactic symptoms in its use.

Hecodes is a solution of the isoncotic type - during the infusion of this substance, the plasma volume inside the vessels increases in proportion to the volume of the drug administered.

The duration of the vollemic action depends first of all on the parameters of the molar substitution, and also on the average value of the molecular weight.

The HES element undergoes a prolonged hydrolysis process, as a result of which active poly- and oligosaccharides of the oncotic type are formed having a diverse molecular mass. These substances are excreted through the kidneys.

The drug helps to reduce the level of viscosity of the blood plasma (among them hematocrit). The volemic effect after isovolemic administration of the solution lasts for a minimum of 6 hours.

Pharmacokinetics

HES is the mixing of a variety of molecules that have different levels of molar substitution, and at the same time different molecular weight values (both of these factors affect the rate of excretion). Small molecules are excreted by filtering the glomeruli, and large molecules undergo hydrolysis with enzymes and with the participation of α-amylase, and then excreted through the kidneys. The rate of hydrolysis processes decreases in proportion to the increase in the level of molecular substitution. About 50% of the substance is excreted in the urine in a period of 24 hours.

After a one-time infusion of a solution of 1000 ml, the plasma clearance reaches a value of 19 ml / minute, and the total absorption of the drug is 58 mg / h / ml. Serum half-life of the substance is 12 hours.

Dosing and administration

The medicine needs to be prescribed in the smallest doses that can ensure the effectiveness of drugs, for a short time interval. In the process of therapy, it is required to constantly monitor hemodynamic parameters. After reaching the required level of these indicators, you must immediately stop treatment.

Enter Hecodesh must be in / in the method. The size of the daily dose, as well as the rate of its administration depend on the values of hemodynamics and the volume of blood loss.

The initial 10-20 ml of the solution should be administered at a slow speed (not more than 500 ml / hour - 0.1 ml / kg / minute). For the patient, the treating doctor should observe the procedure at all times in order to prevent the development of anaphylactoid manifestations.

For a day, not more than 50 ml / kg of medication is allowed (ie 3 g of HES / kg solution per day - approximately 3,500 ml / day with a patient weight of 70 kg).

The maximum rate of administration of the solution depends on the clinical picture. In the event of a shock, infusion is recommended at a rate of up to 20 ml / kg / h (approximately 0.33 ml / kg / minute - 1.2 g / kg / h). If the patient is in a critical condition, a rapid injection of the drug under pressure (a dose of 500 ml) can be performed. During infusion under pressure, if the drug is used in plastic containers, it is first necessary to remove all air from the container itself and the infusion system. This is necessary to prevent the possibility of embolism.

The duration of the treatment course depends on the severity, as well as the duration of hypovolemia, and in addition to the hemodynamic effects of the drug and the indicator of hemodilution.

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Use of the gekodeza during pregnancy

There is no clinical information regarding the current use of infusion during pregnancy. Animal tests showed no adverse effects (both direct and indirect) on the course of pregnancy, and at the same time on fetal development, the process of delivery and the period of postnatal development. In addition, there was no evidence of teratogenicity.

Use Hecodez during pregnancy is only allowed in situations where it is expected that the benefits of therapy will be more likely than the risk of complications in the fetus.

There is no clinical information about the use of drugs in lactation.

Contraindications

The main contraindications:

• intolerance of elements of a medicine;
• presence of hypernatremia of pronounced character or hypervolemia;
• water poisoning or hyperchloremia in severe form;
• CHF, hemorrhage of cerebral or intracranial localization and disorders of blood coagulation in severe form;
• insufficiency of a liver of the expressed character;
• dehydration of the body, which requires the restoration of the balance of water with electrolytes;
• kidney failure or PTA;
• the presence of sensitivity relative to HES;
• coagulopathy in severe form or pulmonary edema;
• It is forbidden to persons with transplanted organs, burn wounds and sepsis;
• appointment to people in a critical condition, as there is a possibility of kidney damage, as well as death.

There have been no studies on the effectiveness of drug use in children, as well as its safety. Therefore, prescribe a drug of this category of treated with caution, as well as taking into account the ratio of the likely benefits of Gekodeza and the risk of complications from its use.

Side effects of the gekodeza

Often there are side effects that develop because of the dosage size of the drug and the main therapeutic effects of medicinal solutions of HES. There may be a hypersensitivity of varying severity. Among the symptoms are anaphylactoid manifestations (influenza-like symptoms: muscle, head, and lumbar pains, and in addition tachycardia with bradycardia, bronchial spasms and pulmonary edema of the non-cardial type), pressure decrease, vomiting, urticaria and nausea. In addition, there is chills, anaphylaxis, an increase in temperature, swelling of the legs and an increase in the size of the salivary glands. Coagulation factors may also decrease (due to the hemodilution process due to the administration of the HES solution without the addition of concurrent blood products).

Allergy manifestations are relatively rare and occur regardless of the dosage size of the drug. Often, with prolonged administration of the solution in large doses, the patient develops itchy skin.

Impact on the function of lymph and blood flow: often due to hemodilution, a decrease in the level of hematocrit, as well as the protein concentration in the plasma. Depending on the size of the dose used, the solution is capable of provoking a decrease in the concentration of coagulation factors, thereby affecting the process of blood turnover.

The bleeding period, as well as the level of the APTS index, may increase, but the activity of factor 8 in Willebrand, on the contrary, decreases.

Effects of the drug on biochemical values: the use of the HES element increases the plasma index of α-amylase (due to the formation of a complex starch compound and α-amylase, which is slowly excreted through the kidneys and otherwise). This symptom can be mistaken for a biochemical attack of pancreatitis.

Manifestations of anaphylaxis: as a result of infusion of the HES element, anaphylactic symptoms develop that have a different degree of severity. Because of this, all patients who are given this medication require constant monitoring by physicians. With the development of the initial manifestations of any anaphylactic signs, it is necessary to immediately stop the infusion and provide the patient with emergency help.

Overdose

A too fast drug infusion or an overdose of them can cause hypernatremia or cause a volume overload. As a result, puffiness of the interstitial or peripheral type develops, as well as pulmonary edema and cardiac insufficiency in acute form. With excessive administration of chloride, the appearance of metabolic acidosis of the hyperchloremic type is possible.

In case of initial signs of anaphylaxis or hypervolemic load, it is required to stop the infusion of Hecodeza, and then, if necessary, to take a diuretic.

Interactions with other drugs

To prevent the development of incompatibility, it is prohibited to mix Hecodez with other medicines.

The drug enhances the nephrotoxic properties of antibiotics from the aminoglycoside category.

Infusion of the HES component can lead to an increase in the indices of amylase within the serum. This effect should not be regarded as a disorder in the pancreas, but as a consequence of the formation of a complex compound of the HES and amylase substance, as a result of which the excretion of the substance with the help of the kidneys is further observed, and by another way.

[2], [3]

Storage conditions

The solution must be kept out of the reach of children. Do not freeze. The storage temperature is not more than 25 ° C.

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Shelf life

Gecodes can be used in the period of 2 years from the moment of making the solution.