10% w/v DEXTRAN 40 IN 5% w/v DEXTROSE Infusion/Solution for

What is 10% w/v DEXTRAN 40 IN 5% w/v DEXTROSE

10% w/v Dextran 40 in 5% w/v Dextrose is a sterile, non-pyrogenic intravenous solution composed of two active ingredients:

• Dextran 40 (10% w/v): A low-molecular-weight polysaccharide used primarily as a plasma volume expander.
• Dextrose (5% w/v): A glucose-based carbohydrate providing energy and preventing hypoglycemia during fluid resuscitation.

This combination is delivered in a 500 ml plastic infusion bottle and is primarily used in the treatment of hypovolemia (low blood volume), blood loss, and certain shock states. The Dextran component helps restore circulatory volume by expanding plasma, while dextrose provides a source of immediate energy and hydration.

Key Uses:

• Treatment of hypovolemic shock due to trauma, burns, or surgery
• Volume expansion prior to or during blood transfusion
• Prophylaxis against thromboembolic events (as Dextran can reduce blood viscosity)
• Temporary intravascular volume support during procedures such as dialysis or cardiopulmonary bypass

This formulation is favored in acute care settings due to its dual benefits: maintaining circulatory volume and supporting metabolic needs. However, due to its colloidal nature and potential effects on coagulation and renal function, its use must be carefully monitored.

How to use 10% w/v DEXTRAN 40 IN 5% w/v DEXTROSE

This medication is intended strictly for intravenous administration under the supervision of trained healthcare professionals. It is delivered directly into the circulatory system via an infusion line, typically in acute or emergency care settings.

• Route of Administration: Intravenous infusion (IV drip)
• Form: 500 ml plastic bottle
• Infusion Type: Colloid plasma volume expander

Instructions for Use:

1. Inspect the bottle for leaks, discoloration, or particulate matter before use. Do not use if compromised.
2. Attach the infusion set aseptically, and ensure all connections are sterile and secure.
3. Prime the IV tubing to eliminate air and connect to the patient's IV cannula.
4. Begin infusion at the prescribed rate, typically guided by the patient’s hemodynamic parameters and clinical condition.
5. Monitor the patient’s vital signs, urine output, central venous pressure (if available), and laboratory markers throughout administration.

Important Considerations:

• Infuse cautiously in patients with cardiac, renal, or hepatic impairment.
• Avoid co-infusion with blood products through the same line unless using a compatible Y-connector and flush in between.
• Document fluid intake/output to monitor for fluid overload.

The rate of infusion depends on the severity of hypovolemia and patient tolerance. Rapid administration may be necessary in shock, but slower rates are used in maintenance or prophylactic contexts.

Mode of Action 10% w/v DEXTRAN 40 IN 5% w/v DEXTROSE

This formulation has a dual mechanism of action, owing to its two pharmacologically active components: Dextran 40 and Dextrose 5%.

• Dextran 40: A low-molecular-weight polysaccharide (average molecular weight ~40,000 Daltons) that acts as a plasma volume expander.
• Dextrose 5%: Provides readily available glucose for cellular metabolism and prevents hypoglycemia during fluid therapy.

Dextran 40 Mechanism:

• Increases plasma volume by creating oncotic pressure in the vascular compartment, drawing water from the interstitial space into the bloodstream.
• Improves microcirculation by reducing blood viscosity and improving flow properties.
• Has mild antithrombotic effects by inhibiting platelet aggregation and reducing blood viscosity.

Dextrose Mechanism:

• Acts as a metabolic substrate for ATP production in tissues.
• Prevents protein catabolism and ketosis during acute fluid therapy.
• Maintains normoglycemia in patients at risk for hypoglycemia.

Overall Physiological Effects:

• Rapid plasma expansion supports blood pressure and organ perfusion in hypovolemia or shock.
• Improved blood flow to capillaries and peripheral tissues
• Temporary energy supply for metabolically stressed or fasting patients

This dual action makes it an effective short-term resuscitation fluid, particularly useful in emergency or perioperative settings.

10% w/v DEXTRAN 40 IN 5% w/v DEXTROSE Interactions 10% w/v DEXTRAN 40 IN 5% w/v DEXTROSE

This IV infusion solution, though highly beneficial in specific clinical scenarios, may interact with certain drugs or physiological conditions. Understanding these interactions is essential for safe administration and optimal therapeutic outcomes.

• Anticoagulants and Antiplatelets: Dextran 40 has mild antithrombotic effects by inhibiting platelet aggregation and fibrin polymerization. When used alongside agents such as heparin, warfarin, or aspirin, it may potentiate bleeding risks. Co-administration should be closely monitored with coagulation parameters (PT, INR, aPTT).
• Diuretics: Concurrent use with diuretics like furosemide or mannitol may increase the risk of electrolyte imbalance and dehydration, especially if fluid balance is not monitored accurately.
• Blood Products: Dextran can interfere with cross-matching of blood due to its ability to coat red blood cells. If blood transfusion is necessary, administer through a separate IV line, and inform the blood bank before transfusion.
• Nephrotoxic Drugs: Dextran can sometimes precipitate osmotic nephrosis or exacerbate renal dysfunction. Combined use with drugs like aminoglycosides or NSAIDs (e.g., ibuprofen, indomethacin) requires extra caution.
• Insulin and Glucose-lowering Agents: Due to the dextrose component, patients receiving insulin or other hypoglycemic drugs may require dosage adjustments to maintain euglycemia.

Clinical Interactions to Watch For:

• Volume overload when combined with other colloids or large-volume crystalloids
• Hyperglycemia in diabetic patients or critically ill individuals on total parenteral nutrition (TPN)
• Interference with laboratory values like hematocrit, protein levels, and glucose monitoring

Recommendation: Always review the patient’s medication profile before initiating therapy. Monitor blood glucose, renal function, and coagulation status regularly during administration.

Dosage of 10% w/v DEXTRAN 40 IN 5% w/v DEXTROSE

The dosage of this infusion must be individualized based on the clinical scenario, patient weight, hemodynamic status, and laboratory values. It is intended for short-term volume replacement and should be administered under close medical supervision.

• Adults: Initial dose is typically 500 to 1000 ml (1–2 bottles), administered at a rate of 20–40 ml/min depending on urgency. Total daily dose should not exceed 20 ml/kg or ~1500 ml to avoid volume overload or renal stress.
• Pediatrics: Use with caution. Dosage is weight-based: generally 5–10 ml/kg. Infusion must be slow, with close monitoring of urine output and electrolytes.
• Geriatrics: Lower initial doses (250–500 ml) are often preferred due to reduced cardiac and renal reserve. Titrate slowly to avoid circulatory overload.

Dosage Guidelines Based on Use Case:

• Volume Expansion: Administer rapidly for acute blood loss or hypotension (up to 500 ml in 30–60 minutes).
• Prophylaxis against thrombosis: Administer slowly over 4–6 hours (250–500 ml) post-operatively.

Maximum Dose: Do not exceed 1500 ml/day in adults. In high doses, monitor for signs of volume overload, renal impairment, or coagulation disorders.

Administration Notes:

• Always infuse using sterile, aseptic technique.
• Do not mix with other drugs unless compatibility is confirmed.
• Monitor blood pressure, urine output, central venous pressure (CVP), and signs of allergic reactions throughout the infusion.

Possible side effects of 10% w/v DEXTRAN 40 IN 5% w/v DEXTROSE

Though effective, this infusion solution carries a risk of several potential side effects. These may range from mild infusion-related symptoms to serious complications such as anaphylaxis or renal impairment.

• Allergic Reactions: Rare but potentially severe. Symptoms include urticaria, wheezing, hypotension, chest tightness, and even anaphylactic shock. Always monitor for hypersensitivity during the initial infusion period.
• Volume Overload: Especially in patients with heart failure or renal insufficiency. Signs include pulmonary edema, hypertension, peripheral edema, and dyspnea.
• Renal Effects: Osmotic nephrosis or acute kidney injury can occur, particularly in those with pre-existing renal disease or when high doses are administered.
• Coagulation Abnormalities: Dextran may impair platelet function and prolong bleeding time. Bleeding or bruising may be noted, especially if used with anticoagulants.
• Metabolic Disturbances: Due to the dextrose component, hyperglycemia or glucosuria may occur, particularly in diabetic or critically ill patients.
• Infusion-related Effects: Pain or inflammation at the infusion site, phlebitis, or extravasation injury may occur if administration is not properly managed.

Signs of Serious Adverse Effects:

• Sudden drop in blood pressure or cardiac arrhythmia
• Severe back or chest pain
• Reduced urine output or hematuria
• Respiratory distress or cyanosis

Prompt discontinuation and emergency treatment are necessary if severe reactions occur. It is also advisable to have resuscitation equipment and medications (e.g., adrenaline, corticosteroids, antihistamines) on standby during the infusion.

10% w/v DEXTRAN 40 IN 5% w/v DEXTROSE Contraindications 10% w/v DEXTRAN 40 IN 5% w/v DEXTROSE

This infusion solution is contraindicated in several clinical conditions. Using it in such cases may worsen patient outcomes or result in serious adverse reactions.

• Severe Congestive Heart Failure (CHF): Risk of circulatory overload, pulmonary edema, and cardiac decompensation.
• Severe Renal Impairment or Anuria: Increases the risk of fluid retention, renal stress, and nephrotoxicity. Avoid unless on renal replacement therapy.
• Known Hypersensitivity to Dextran: History of allergic reactions or anaphylaxis to dextran is an absolute contraindication.
• Uncontrolled Diabetes Mellitus: The dextrose component can exacerbate hyperglycemia and associated complications.
• Coagulopathy or Active Bleeding: Dextran may impair platelet function and increase bleeding risk, particularly in patients with hemophilia, thrombocytopenia, or on anticoagulants.
• Severe Dehydration with Electrolyte Imbalance: This solution does not provide adequate electrolytes and may exacerbate hyponatremia or hypokalemia.

Relative Contraindications / Cautions:

• Pregnancy and lactation (insufficient safety data – use only if clearly indicated)
• Advanced liver disease (affects glucose metabolism and coagulation)
• Recent hemorrhagic stroke (risk of increased bleeding and ICP)

Thorough assessment and pre-infusion screening, including renal function, coagulation profile, and glucose levels, are essential prior to administration. If contraindications are present, consider safer alternatives such as isotonic crystalloids or albumin-based products.

Storage of 10% w/v DEXTRAN 40 IN 5% w/v DEXTROSE

Proper storage of intravenous (IV) solutions is crucial to ensure their safety, sterility, and therapeutic effectiveness. This includes preventing degradation of active ingredients and maintaining the integrity of the packaging. The following are key storage recommendations for 10% w/v Dextran 40 in 5% w/v Dextrose:

• Storage Temperature: Store the solution at a controlled room temperature between 15°C and 25°C (59°F to 77°F). Avoid extreme heat or freezing conditions as these can affect both the solution and the plastic container.
• Protection from Light: Although the solution is generally stable, prolonged exposure to direct sunlight or UV radiation should be avoided. Store in a shaded area or inside its protective outer carton if applicable.
• Humidity Considerations: Store in a dry place to prevent any compromise to the packaging. Avoid storing near sinks, damp areas, or in environments with high humidity.

Handling Precautions:

• Inspect the bottle before use. Do not use if the solution appears cloudy, discolored, or contains visible particulates.
• Do not use the container if it is leaking, punctured, or shows any sign of damage.
• The outer packaging (if present) should be kept intact until the point of use to maintain sterility and reduce risk of contamination.

After Opening:

• This solution is intended for single use only. Once the bottle is opened, it must be used immediately under aseptic conditions.
• Any unused portion should be discarded. Do not store opened bottles for later use or reuse for another patient.

Shelf Life: Refer to the manufacturer’s label or product insert for the expiration date. Do not use beyond this date.

Disposal: Dispose of unused or expired bottles and used infusion sets in accordance with hospital guidelines and local regulatory requirements. Do not flush down sinks or discard in regular trash if not permitted.

By maintaining proper storage conditions, healthcare providers ensure the medication’s stability, sterility, and efficacy, thereby safeguarding patient safety and treatment quality.