Dextran 40

Shock

Early fluid replacement and plasma volume expansion in the adjunctive treatment of certain types of shock or impending shock (e.g., burns, surgery, hemorrhage, or other trauma in which a circulating volume deficit is present) when whole blood or blood products are not available, or when the need for haste precludes the necessary cross-matching of blood.a b

Minimizes sludging of blood as a result of microcirculation effects.a

Not a replacement for other forms of therapy; complementary to fluids and electrolytes.a b

Extracorporeal Circulation

Priming fluid (alone or as an additive to other priming fluids) in pump oxygenators for perfusion during extracorporeal circulation.a b

Prophylaxis of Thromboembolic Disorders

Prophylaxis of venous thrombosis and pulmonary embolism for surgical procedures associated with a high risk of thromboembolic complications (e.g., hip surgery).a b

May be beneficial in patients undergoing hip surgery; however, has not been shown to be more effective than oral anticoagulants or heparin in patients undergoing general surgery.a

The American College of Chest Physicians (ACCP) does not recommend as sole method of thromboprophylaxis in elective hip arthroplasty.200

Administration

IV Administration

For solution and drug compatibility information, see Compatibility under Stability.

Administer by IV infusion.a b Preservative-free, single-use container; discard unused portion.b

Administer 20 mL dextran 1 before administration of dextran 40.b (See Sensitivity Reactions under Cautions.)

When infusing concentrated dextran 40, use an administration set with a filter.b An administration set is provided with commercially available preparation; consult the manufacturer’s instructions for proper use.b

Generally, initiate dextran 40 therapy during the surgical procedure.a

Infusion rate is dependent on patient-specific requirements (e.g., amount of fluid loss, resultant hemoconcentration).a May infuse the first 500 mL (10 mL/kg) of solution rapidly if closely monitoring central venous pressure; however, infuse the remainder of the dose slowly.a b (See Circulatory and/or Volume Overload in Warnings.)

If not monitoring central venous pressure, infuse drug more slowly; closely observe patient for signs of circulatory overload.a

Dosage

Pediatric Patients

Adjust dosage and rate of infusion based on individual patient requirements, amount of fluid loss and resultant hemoconcentration.a (See Rate of Administration under Administration.)

Infants: 0.5 g/kg (5 mL/kg).b

Children: 1 g/kg (10 mL/kg).b

Adolescents: Maximum total dosage (first 24 hours) of 2 g/kg (20 mL/kg); thereafter, maximum dosage of 1 g/kg (10 mL/kg) daily for up to 5 days.b

Infants: 0.5 g/kg (5 mL/kg).b

Children: 1 g/kg (10 mL/kg).b

Infants: 0.5 g/kg (5 mL/kg).b

Children: 1 g/kg (10 mL/kg).b

Adolescents: Select dosage according to the risk of thromboembolic complications (e.g., type of surgery, duration of immobilization).b Generally, the day of surgery, 50–100 g (500–1000 mL [approximately 10 mL/kg]).b Then, 50 g (500 mL) daily for an additional 2–3 days.b Thereafter, may give 50 g (500 mL) every 2–3 days for up to 2 weeks, according to the risk of thromboembolic complications.b

Adults

Adjust dosage and rate of infusion based on individual patient requirements, amount of fluid loss, and resultant hemoconcentration.a (See Rate of Administration under Administration.)

Maximum total dosage (first 24 hours): 2 g/kg (20 mL/kg); thereafter, maximum dosage of 1 g/kg (10 mL/kg) daily for up to 5 days.a b

Usual dose: 1–2 g/kg (10–20 mL/kg); maximum 2 g/kg (20 mL/kg).a b The amount of solution used varies with the volume of the pump oxygenator.a b

Select dosage according to the risk of thromboembolic complications (e.g., type of surgery, duration of immobilization).b

Generally, the day of surgery, 50–100 g (500–1000 mL [approximately 10 mL/kg]).a b Then, 50 g (500 mL) daily for an additional 2–3 days.a b Thereafter, may give 50 g (500 mL) every 2–3 days for up to 2 weeks, according to the risk of thromboembolic complications.a b

Prescribing Limits

Pediatric Patients

Adolescents (first 24 hours): Maximum of 2 g/kg (20 mL/kg).b Thereafter, maximum of 1 g/kg (10 mL/kg) daily.b Maximum duration: 5 days.b

Adults

First 24 hours: Maximum of 2 g/kg (20 mL/kg).a b Thereafter, maximum of 1g/kg ( 10 mL/kg daily).a b

Maximum duration: 5 days.a b

Total dosage: Maximum 2 g/kg (20 mL/kg).b

Special Populations

Hepatic Impairment

No specific dosage recommendations at this time.b (See Hepatic Effects under Cautions.)

Renal Impairment

In advanced renal disease, do not exceed maximum recommended dosages.b (See Renal Effects, Sodium Content, and Renal Impairment under Cautions.)

Geriatric Patients

No specific dosage recommendations at this time except those related to renal impairment.b

Absorption

Onset

Maximum plasma volume reached within several minutes after the end of the infusion.a

Duration

Extent and duration of the expansion in plasma volume vary with the volume infused, preadministration plasma volume, and the rate of renal clearance.a

Plasma Concentrations

Plasma concentration depends on the rate of infusion, the total amount of drug administered, and the rate of disappearance of the drug from plasma.a

In normal renal function, plasma concentration falls rapidly during the first hour following infusion and more slowly thereafter.a

Distribution

Extent

Evenly distributed in the vascular system.b

Not known whether dextran 40 is distributed into milk.a

Elimination

Metabolism

Large, unexcreted molecules (molecular weight ≥50,000) slowly degraded by dextranase enzyme to glucose which is metabolized to carbon dioxide and water.a b

Elimination Route

In normovolemic patients, principally excreted unchanged in urine (approximately 75%) within 24 hours; small amounts eliminated in feces.a b

Storage

Parenteral

Constant temperature, preferably 25°C (may be exposed to ≤40°C).a b Protect from freezing and excessive heat.b

Dextran flakes may form in solution when stored for long periods or if storage temperature varies greatly.a Dissolve flakes by heating solution in a water bath at 100°C until clear, or by autoclaving at 110°C for 15 minutes.a

Compatibility

For information on systemic interactions resulting from concomitant use, see Interactions.

Parenteral

• Low molecular weight polymer of glucose.a

• Plasma volume expansion results from a colloidal osmotic effect in drawing fluid from the interstitial to the intravascular spaces; plasma volume expansion is slightly greater than the volume of dextran infused.a b

• Plasma volume expansion is accompanied by an increase in central venous pressure, cardiac output, stroke volume, BP, urinary output, capillary perfusion, and pulse pressure, and by a decrease in heart rate, peripheral resistance, blood viscosity, and mean transit time.a b

• Enhances blood flow through correction of hypovolemia and improved microcirculation. a b

• May coat erythrocytes and other formed elements, reducing bonding forces and maintaining the erythrocytes in a state of electronegativity and mutual repellency.a b May decrease erythrocyte rigidity, facilitating passage through small blood vessels.a

• Dextrose provides calories, restores blood glucose concentrations, has a protein-sparing effect; may help minimize liver glycogen depletion.b