Dextran is available as Dextran 40 and Dextran 70 depending on the molecular mass. It is used in volume expansion in hypotensive patients and as a plasma expander in patients with capillary leak syndromes.

Dextran Uses:

• It is indicated as a blood volume expander that is used in the treatment of shock or impending shock when blood or blood products are not available.
• It is also used as a priming fluid in pump oxygenators during cardiopulmonary bypass.

Dextran Dose in Adults

Dextran Dose for Volume expansion or the management of shock:

• IV: Dextran 40:
  • Infuse 500-1000 mL (about 10 mL/kg) as rapidly as possible
  • The maximum dose: 20 mL/kg/day for the first 24 hours; 10 mL/kg/day thereafter;
  • The treatment should not be continued beyond 5 days.
  • Note: Current Surviving Sepsis Campaign International Guidelines for Management of Severe Sepsis and Septic Shock recommend crystalloids, rather than colloids, as the initial fluid of choice in the resuscitation of severe sepsis and septic shock.

Dose in the Pump prime:

• Dextran 40:
  • The volume of infusion varies with the volume of the pump oxygenator;
  • Generally, the solution is added in a dose of 10-20 mL/kg (or 1-2 g/kg);
  • The usual maximum total dose: 20 mL/kg (or 2 g/kg)

Dextran Dose in Childrens

Note: Dose and infusion rate are dependent upon the patient's fluid status and must be individualized.

Dextran Dose in the management of Shock:

Note: Crystalloids rather than colloids are recommended as the initial fluid of choice in the resuscitation of patients with severe sepsis and septic shock:

• Infants, Children, and Adolescents:
  • Initial: IV Bolus: 20 mL/kg over at least 5 minutes; repeat as needed based on response (ACCM [Davis 2017]; SCCM [Dellinger 2013])

Dextran Dose for Volume expansion (nonshock like conditions):

• Infants:
  • IV: Infuse 5 mL/kg as rapidly as necessary;
  • The maximum daily dose: 20 mL/kg/day for the first 24 hours, then 10 mL/kg/day thereafter;
  • The treatment should not be continued beyond 5 days
• Children and Adolescents <50 kg:
  • IV: Infuse 10 mL/kg as rapidly as necessary;
  • The maximum daily dose: 20 mL/kg/day for the first 24 hours, then 10 mL/kg/day thereafter;
  • The treatment should not be continued beyond 5 days
• Adolescents ≥50 kg:
  • IV: Infuse 500 to 1,000 mL (about 10 mL/kg) as rapidly as necessary;
  • The maximum daily dose: 20 mL/kg/day for the first 24 hours, then 10 mL/kg/day thereafter;
  • Treatment should not be continued beyond 5 days.

Dose for priming the pump: IV:

Note: Dose will vary with the volume of the pump oxygenator; doses usually added to the perfusion circuit.

• Infants:
  • 5 mL/kg;
  • The usual maximum total dose: 20 mL/kg/day
• Children:
  • 10 mL/kg;
  • The usual maximum total dose: 20 mL/kg/day
• Adolescents:
  • 10 to 20 mL/kg;
  • The usual maximum total dose: 20 mL/kg/day

Dextran Pregnancy Risk Category: C

• Studies on animal reproduction have not been done.

Use during breastfeeding:

• It is unknown whether dextran is excreted into breastmilk.
• It is recommended that you use it with caution if you are lactating.

Dose in Kidney Disease:

• Use with extreme caution.

Dose in Liver disease:

• Use with extreme caution.

Side effects of Dextran:

• Cardiovascular:
  • Chest tightness
  • Hypotension
• Dermatologic:
  • Urticaria
• Gastrointestinal:
  • Nausea
  • Vomiting
• Hematologic & oncologic:
  • Prolonged bleeding time (dose-related)
  • Wound hemorrhage (dose related)
  • Wound hematoma (dose-related)
• Hepatic:
  • Abnormal liver function tests
• Hypersensitivity:
  • Anaphylactoid reaction
• Renal:
  • Acute renal failure
• Respiratory:
  • Pulmonary edema (dose-related)
  • Wheezing  

Contraindications to Dextran:

• Allergy to dextran, or any component of this formulation
• Hemostatic disorders such as thrombocytopenia or hypofibrinogenemia (including those caused from medications like warfarin and heparin)
• Marked cardiac decompensation;
• Renal disease with severe anuria or oliguria.

Warnings and precautions

• Fluid overload:
  • Fluid overload could result. Dextran should not be given to patients at high risk for fluid overload, such as the elderly and very young.
• Hematologic:
  • Infusions exceeding 1000 ml can cause hemoglobin to drop and plasma proteins to dilution.
  • It is possible for the bleeding to continue longer. Stop the infusion if the hematocrit falls below 30%.
• Hypersensitivity
  • Reports of severe and sometimes life-threatening anaphylactoid reactions to the medication have been made.
  • If you notice any signs of hypersensitivity, discontinue use immediately and provide appropriate treatment.
• Failure of the renal system:
  • It has been linked to renal failure. You should monitor fluid levels and urine output.
• Heart failure:
  • During treatment, monitor the patient for signs and symptoms of fluid overload or heart failure.
• Hemorrhage:
  • It can increase hemorhage risk. It should be avoided by patients with active bleeding.
• Renal impairment
  • Patients with impaired renal function should be cautious and monitor fluid levels and urine output.
  • Patients with kidney disease should avoid excessive use of it in anuria and oliguria.
• Thrombocytopenia:
  • Patients with low platelets need to be cautious when taking this medication. 
  • Patients with low platelets should not take more than 1000ml.
  • This could cause problems with platelet function, and can prolong bleeding. Bleeding should be monitored in patients.

Dextran: Drug Interaction

Note: Drug Interaction Categories:

• Risk Factor C: Monitor When Using Combination
• Risk Factor D: Consider Treatment Modification
• Risk Factor X: Avoid Concomitant Use

Monitoring parameters:

• Blood pressure, heart rate, CVP, mean arterial pressure, and capillary refill time;
• Monitor cardiac index, PCWP, SVR, and PVR if a pulmonary catheter is in place;
• Hemoglobin and hematocrit,
• Serum electrolytes,
• Serum protein,
• Coagulation parameters,
• Renal function, urine output, and acid-base balance;
• Observe the patients for allergic reactions during the first minute of infusion. Replace with another fluid if any reaction is suspected.

How to administer Dextran?

• It is administered intravenously only as an intravenous infusion.
• It may be infused using an infusion pump or pressure infusion.
• Patients who are hypotensive or in shock may be given the initial infusion as rapidly as possible.
• Patients should be monitored for anaphylactic shock and hypersensitivity reactions.
• Epinephrine should be available for resuscitation if any reactions occur.
• Avoid administering the drug if the infusion has precipitates in it.   

Mechanism of action of Dextran:

It is highly colloidal and produces plasma volume expansion by drawing water from the extracellular space.

Time:

• Plasma expanding effects last for 3-4 hours

Excretion:

• Urine (approximately 75%) within 24 Hours

 International Brand Names of Dextran:

• LMD in D5W
• LMD in NaCl
• Dekstran 40000
• Dekstran 70000
• Deltadex
• Dextran 40
• Dextran 40 Injection
• Dextran 70
• Dextran 70 Injection
• Gentran
• Gentran 40
• Gentran 70
• LM Dextran
• Longasteril 40°
• Macrodex 10%
• Plander
• Plasmex
• Rheomacrodex
• Soludeks 40
• Soludeks 70

Dextran Brand Names in Pakistan: