A sterile, pyrogen-free, colloidal plasma volume expander and priming solution for extracorporeal circulation, containing low molecular weight dextran (average molecular weight 40,000 Da) in 5% dextrose. It is primarily used for its immediate volume-expanding effects and to improve microcirculatory flow by reducing blood viscosity and inhibiting erythrocyte aggregation. The dextrose provides a small amount of caloric support and helps maintain the isotonicity of the solution.
Adult: Initial: 500-1000 mL infused rapidly IV. Maintenance: Total daily dose should not exceed 20 mL/kg (approx. 1.5 L for a 75 kg adult). For shock: Up to 2 L may be given in the first 24 hours, with rate titrated to BP, CVP, and urine output. For priming: Volume as required by the extracorporeal circuit (usually 500-1000 mL).
Note: For IV infusion only. Use a sterile, non-pyrogenic administration set. The initial 10-20 mL should be infused slowly while monitoring for anaphylactoid reactions. Subsequent rate is determined by clinical indication: rapid for shock (e.g., 20-40 mL/min), slower for maintenance. Do not mix with blood for transfusion through the same set (can cause pseudoagglutination). Can be given through a peripheral or central line.
Dextran 40 exerts its primary effect through colloid osmotic pressure. When infused intravenously, it draws water from the interstitial space into the intravascular compartment, rapidly expanding plasma volume. Its low molecular weight and high oncotic pressure (twice that of albumin) make it an efficient short-term volume expander. Furthermore, it coats the surface of red blood cells and platelets, increasing their negative charge (zeta potential), which reduces erythrocyte aggregation (rouleaux formation) and platelet adhesiveness. This decreases blood viscosity, especially at low shear rates, and improves microcirculatory flow in conditions of sludging.
Pregnancy: Category C. Should be used only if clearly needed. No well-controlled studies in pregnant women. Benefit must outweigh potential risks to fetus. Monitor for fluid overload.
Driving: No effect. The drug is administered in a controlled clinical setting.
| Anticoagulants (Warfarin, Heparin) | Additive effect on bleeding time; increased risk of hemorrhage. | Major |
| Anti-platelet drugs (Aspirin, Clopidogrel) | Increased risk of bleeding. | Moderate |
| ACE Inhibitors (e.g., Enalapril) | Increased risk of anaphylactoid reactions. | Moderate |
| Cephalosporins (some) | Potential for increased nephrotoxicity. | Moderate |
| Insulin | Dextrose content may alter insulin requirements in diabetics. | Moderate |
Same composition (Dextran 40 (10gm) + Dextrose (5gm)), different brands: