Hydroxyethyl Starch (HES) 3% w/v is a synthetic, sterile, non-pyrogenic colloidal plasma volume expander derived from waxy maize starch. It is formulated in a balanced electrolyte solution (typically Plasma-Lyte or similar) to approximate the ionic composition of plasma. In the Indian context, it is primarily used for intravascular volume replacement in hypovolemic states, particularly in surgical and critical care settings. Its use has become more restricted globally and in India due to safety concerns regarding renal impairment and pruritus, leading to specific risk minimization measures mandated by the Indian regulatory authority (CDSCO).
Adult: Dosage is highly individualized based on blood loss, hemodynamic status, and ongoing losses. Typical initial dose: 500-1000 mL (approx. 10-15 mL/kg) infused IV. Maximum daily dose should not exceed 33 mL/kg (approx. 1500-2000 mL for a 60 kg adult). Total cumulative dose should be limited to 1500-2000 mL per day. Therapy should not exceed 72 hours.
Note: For intravenous infusion only. Use a sterile administration set. Do not mix with other drugs in the same infusion set. The infusion rate should be titrated according to the patient's hemodynamic response (blood pressure, heart rate, CVP). Usually administered as a rapid infusion (e.g., 500 mL over 30-60 minutes) in acute hypovolemia. Monitor closely for signs of fluid overload (dyspnea, pulmonary edema).
HES 3% w/v is an isotonic colloidal solution. Its primary mechanism is based on generating oncotic pressure. When infused intravenously, the large HES molecules remain predominantly within the intravascular compartment (at least initially), creating an osmotic gradient that draws fluid from the interstitial space into the bloodstream. This results in rapid plasma volume expansion, increased cardiac preload, and improved hemodynamics. The degree and duration of volume expansion depend on its concentration, average molecular weight (Mw), molar substitution (MS), and the C2/C6 hydroxyethylation ratio.
Pregnancy: Category C: Animal reproduction studies have shown adverse effects, but there are no adequate and well-controlled studies in pregnant women. Use only if the potential benefit justifies the potential risk to the fetus. Should be avoided, especially during the first trimester. Preferred volume expanders in pregnancy are crystalloids or albumin.
Driving: Unlikely to affect driving ability as used in hospitalized settings. However, post-infusion dizziness or pruritus could theoretically impair focus.
| Anticoagulants (Heparin, Warfarin, DOACs) | Additive effect on coagulation impairment, increased risk of bleeding. | Major |
| Antiplatelet drugs (Aspirin, Clopidogrel) | Increased risk of bleeding due to additive effects on platelet function. | Major |
| ACE Inhibitors (e.g., Enalapril) or ARBs | Increased risk of anaphylactoid reactions. Concurrent use may also impair renal perfusion. | Moderate |
| Diuretics (e.g., Furosemide) | HES may reduce renal responsiveness to diuretics. Concurrent use for fluid overload requires caution. | Moderate |
| Other Plasma Expanders (Albumin, Gelatins) | Additive risk of volume overload and dilutional effects. | Moderate |
Same composition (Hydroxyethyl Starch(HES) (3% w/v)), different brands: