HES

Gek is a solution of perfusion type and blood substitute. Included in the category of drugs is hydroxyethyl starch.

[1]

Indicações Geka

It is used to eliminate hypovolemia, which arose because of acute blood loss (in situations where the use of exclusively crystalloids was found to be ineffective).

[2], [3], [4], [5], [6], [7], [8], [9], [10]

Forma de liberação

Release in the form of an infusion solution in flakonchikah of polyethylene or glass, a volume of 250 or 500 ml. Inside a separate package - 1 or 10 bottles.

[11]

Farmacodinâmica

Medication Gek is a colloidal-type plasma substitute. It contains hydroxyethyl starch, which dissolves inside an isotonic solution of sodium chloride.

The duration of exposure to drugs that contribute to an increase in the plasma volume is more dependent on the values of the M3, and on the MM, to a lesser extent. After the procedure of hydrolysis of polymers of HES substance, performed in / in the method, small molecules are always formed. They have oncotic activity, and then are excreted through the kidneys.

During the introduction of infusion, the level of hematocrit decreases, as well as the viscosity index of the blood plasma.

After the infusion of the drug in people with hypovolemia, the volume of blood circulating through the body is normalized, and in addition there is an improvement in cardiac function and hemodynamics. The blood volume is kept at the optimal level for a minimum of 6 hours.

[12], [13], [14], [15], [16]

Farmacocinética

After parenteral infusion, the bioavailability level of the drug is 100%. The parameters of the preparation are not the same as those of a standard molecularly homogeneous component, but are more similar to the characteristics of a mixture of several separate elements that differ in molecular weight, and the degree of substitution. Therefore existing now generally accepted rules of pharmacokinetic parameters can be applied to Hack only with great limitations, because its properties are constantly changing over time.

In persons taking the medicine, the most important in the process of assessing the indices of the replacement volume of the circulating blood inside the body is the time interval during which support is provided for the effects of replenishment of this volume achieved with the help of the HES substance. Therefore, when comparing drugs, it is allowed to use the indices of the duration of the presence of plasma substitutes inside the body (this is expressed as the initial half-life - provided that there are no differences in the measurement intervals, and in addition to the dosage of the infusion and its circulation).

The initial half-life of the substance from the blood serum depends on the type of infusion and the rate of its administration, and is approximately 5-7 hours.

Molecules of the HES element, having a size smaller than the elimination threshold, are excreted by the kidneys, by filtering the glomeruli. With a single use of a dosage of 500 ml, about 50% of the injected drug is detected inside the urine in a period of 24 hours.

[17], [18], [19], [20], [21], [22], [23], [24], [25], [26],

Dosagem e administração

You can use the Hack only at the initial stage of recovery of the optimal level of volume - the maximum time interval is 24 hours.

The initial 10-20 ml of the drug is administered slowly, carefully following the patient's condition (to prevent the development of anaphylactic manifestations).

Prescribe medication in minimal effective dosages, and for a short time interval. In the process of therapy, continuous monitoring of hemodynamics with immediate abolition of the drug is required immediately after reaching the required hemodynamic values. Do not exceed the specified dosage limits.

During the day, you can enter no more than 18 ml / kg of medication (this figure is equivalent to 1.8 g / kg of HES). Taking into account the function of cardiac blood flow, the speed of the performed infusion should not exceed the value of 18 ml / kg for 1 hour.

The solution is administered exclusively by iv injection.

[41], [42], [43], [44], [45], [46]

Uso Geka durante a gravidez

There have been no studies on the safety of HES use in pregnant women. This infusion solution is forbidden to be administered on the 1st trimester, and during the 2nd and 3rd it can be used only if there are life indications (in cases when the doctor believes that the possible benefit for a woman exceeds the probable risk of complications in the fetus) .

Since there is no information on the ingestion of the active substance into the mother's milk, it is necessary to carefully appoint Gek to nursing mothers.

Contra-indicações

The main contraindications:

• the presence of intolerance relative to the active component or other elements of the drug;
• the presence of burns or sepsis;
• people in critical condition;
• PTA or kidney failure;
• coagulopathy in severe form, as well as hypervolemia;
• cerebral or intracranial hemorrhage;
• heart failure of a stagnant type;
• hypokalemia, as well as severe forms of hypernatremia or hyperchloremia;
• functional hepatic disorders in severe form;
• patients immediately after organ transplant;
• pulmonary edema;
• Hyperhydria or vice versa dehydration;
• patients in childhood.

[27], [28], [29], [30], [31], [32]

Efeitos colaterais Geka

Use of the solution can cause the appearance of such side effects:

• disorders of the lymph and hematopoietic system: a decrease in hematocrit, as well as plasma protein levels due to the dilution of blood. Large dosages of the drug can cause liquefaction of concentrated coagulation factors, and as such can have an effect on blood flowability. Perhaps an extension of bleeding time. But the effects on platelet function are not revealed, as is the drug-significant bleeding. With the rapid introduction of drugs (or administration in large quantities), a rapid increase in the volume of circulating blood is possible;
• reactions of the digestive system: liver damage is possible;
• manifestations from the subcutaneous layer with the skin: prolonged use of the drug can provoke itching (it can develop after the end of the course of therapy and last for several months, causing quite unpleasant sensations);
• results of laboratory tests and studies: after the procedure of infusion, the amylase index inside the serum increases substantially, but this can not be considered a symptom of pancreatic disease. The development of hyperamylasemia is associated with the formation of a complex called "HES-amylase," which is excreted quite slowly by the kidneys;
• disturbances in the function of the urinary system and kidneys: occasionally there were pains in the lumbar region. If such symptoms appear, you need to stop the infusion and ensure that the necessary amount of fluid enters the body, while carefully monitoring serum creatinine. Kidney damage is also possible;
• immune manifestations: anaphylactic symptoms with varying degrees of severity. There is information about the development of anaphylactic manifestations when using geck - among them a slight increase in temperature, vomiting, itching, a feeling of cold, and also hives. It is also possible to increase the salivary glands in the area under the jaw and near the ears, and in addition to the appearance of weak influenza-like symptoms (headaches or muscle pains) and swelling on the legs. There are also severe hypersensitivity reactions against which a shock state develops, and life-threatening manifestations (stopping of breathing and heart) appear, but they are isolated. In case of the appearance of symptoms of hypersensitivity, it is necessary immediately to stop the infusion and begin to perform the generally accepted procedures of rendering first aid;
• signs of anaphylaxis: these manifestations can develop in a few minutes. Among the manifestations that may be a warning sign - a sudden redness of the skin or the development of severe itching. In some cases, the patient feels choking, a feeling of coma in the throat. With the progression of the disorder, abdominal cramps, nausea and tachycardia appear, as well as a sharp fall in the level of blood pressure, which can cause loss of consciousness, as well as stopping breathing and working the heart.

To eliminate anaphylaxis (in the case of the appearance of the first symptoms - nausea and skin manifestations), it is necessary to stop the infusion procedure, leaving the cannula inside the vein or providing the necessary access to it in another way. Further, the patient should be positioned so that his head is lowered, and then release his respiratory ducts. In addition, an immediate adrenaline injection with an IV method is required (an adrenaline solution in the amount of 1 ml should be diluted in 10 ml (proportion 1k1000)). First, 1 ml of the prepared solution (0.1 mg of epinephrine) is introduced, with control over the indices of blood pressure and pulse. To increase the volume index, iv injection of human albumin (5%) is performed. In addition, it is recommended to enter intravenously with prednisolone or another drug from the GCS group (250-1000 mg). Prednisolone is allowed to enter repeatedly. Children dosage of epinephrine with prednisolone should be reduced in view of their weight and age. Other methods are also used, including artificial respiration, the use of oxygen and the intake of antihistamines. To treat the injured is necessary in the intensive care unit.

[33], [34], [35], [36], [37], [38], [39], [40]

Overdose

When acute drug intoxication may develop hypervolemia.

With the development of this violation, immediate removal of the infusion is required, and then, with the appointment of a doctor, a diuretic can be used. If an overdose occurs, there is also a possibility of an increased risk of bleeding.

[47], [48]

Interações com outras drogas

In the case of mixing with infusion solutions, concentrated preparations for the manufacture of these solutions or injection solutions, as well as with powders or other dry elements for the manufacture of injection drugs, each time, very carefully, at least visually, check the miscibility and compatibility of these drugs. But, in any case, it is impossible to exclude medicinal or chemical incompatibility of drugs that is inconspicuous to the eye.

When combined with aminoglycosides, the drug Gek is able to potentiate their nephrotoxic properties.

[49], [50]

Condições de armazenamento

The medicine does not require special conditions for maintenance. Do not reuse the vial that was previously used. The solution must be kept out of reach of small children.

[51], [52]

Validade

Gak is allowed to be used during the 3 years from the date of release of the medicinal product.

[53], [54]