XPAND INJECTION

Indications

• Hypovolemia
• Septic shock
• Trauma
• Surgical blood loss
• Burn injuries

Dosage

Children: Dosage in paediatrics should be determined by clinical guidelines and the individual patient's condition. Refer to the BNF for Children for specific recommendations.

Adults: Dosage depends on clinical condition and response, typically administered as an intravenous infusion. Refer to specific clinical guidelines for detailed dosing.

Mechanism of action

Hydroxyethyl starch works by expanding intravascular volume through its oncotic properties. It increases the osmotic pressure in the blood vessels, leading to fluid retention within the vascular space, which helps to maintain circulation and perfusion to vital organs.

Pharmacodynamics

The pharmacodynamics of hydroxyethyl starch are characterized by its volume-expanding effects. HES solutions can improve cardiac output and tissue perfusion, especially in states of hypovolemia. The duration of action is influenced by the molecular weight and the concentration of the starch solution used. However, prolonged use has been associated with adverse effects, including coagulopathy and renal impairment.

Pharmacokinetics

Hydroxyethyl starch is administered intravenously and its pharmacokinetics are influenced by its molecular weight. It is distributed throughout the vascular compartment and is gradually metabolized by amylases and other enzymes. The elimination half-life can vary based on the formulation, but generally, HES is cleared from circulation over a period of hours to days, depending on the individual's metabolic capacity and renal function.

Pregnancy

Hydroxyethyl starch is generally contraindicated in pregnancy due to potential effects on fetal health.

Breast-feeding

Use is not recommended during breastfeeding as safety has not been established.

Storage

Store in a cool, dry place, away from direct sunlight. Keep out of reach of children.

Indications

• Nutritional supplementation
• Energy source in enteral nutrition
• Excipient in pharmaceutical formulations

Dosage

Children: Refer to specific guidelines or product inserts for dosing information, as it can vary based on the context of use.

Adults: Refer to specific guidelines or product inserts for dosing information, as it can vary based on the context of use.

Mechanism of action

Starch is broken down into glucose units by enzymes such as amylase during digestion. The glucose is then absorbed in the intestines and utilized for energy production in the body's cells. This pathway involves hydrolysis of the glycosidic bonds, converting starch into simpler sugars.

Pharmacodynamics

Starch primarily serves as an energy source. Its digestion and absorption lead to an increase in blood glucose levels, which provides energy for metabolic processes. In this context, it plays a crucial role in maintaining energy homeostasis in the body.

Pharmacokinetics

Starch is not absorbed in its polymeric form; it must first be enzymatically hydrolyzed into simpler sugars such as maltose and glucose. The digestion and absorption of starch occur predominantly in the small intestine, with glucose being readily absorbed into the bloodstream. The rate of absorption can vary depending on the type of starch and its physical form.

Adverse effects

• Allergic reactions
• Gastrointestinal discomfort
• Diarrhea
• Constipation

Precautions

• Use with caution in individuals with known allergies to starch or starch derivatives
• Monitor for gastrointestinal symptoms in patients with a history of digestive disorders

Pregnancy

Starch is generally considered safe for use during pregnancy. However, it should be consumed in moderation as part of a balanced diet.

Breast-feeding

Starch is deemed safe for nursing mothers when used in moderation as part of a balanced diet.

Storage

Store in a cool, dry place away from moisture and direct sunlight.

Formulations

• Powder
• Granules
• Tablets
• Suspensions