Drug reference

Tetrastarch

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 1132, 1133

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

VOLULYTE ® INFUSION Treatment of hypovolaemia due to acute blood loss when crystalloids alone are not sufficient ▶BY INTRAVENOUS INFUSION ▶Adult: Initially 10–20 mL, then increased to up to 30 mL/kilogram daily for a maximum duration of treatment of 24 hours, the initial dose must be given slowly and with careful monitoring of the patient to allow any anaphylactic reaction to be detected as early as possible VOLUVEN ® INFUSION Treatment of hypovolaemia due to acute blood loss when crystalloids alone are not sufficient ▶BY INTRAVENOUS INFUSION ▶Adult: Initially 10–20 mL, then increased to up to 30 mL/kilogram daily for maximum duration of treatment of 24 hours, the initial dose must be given slowly and with careful monitoring of the patient to allow any anaphylactic reaction to be detected as early as possible

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Contra Indications

Burns. cerebral haemorrhage. congestive heart failure. critically ill patients. dehydration . hyperhydration. intracranial haemorrhage. organ transplant patients. pulmonary oedema. sepsis. severe coagulopathy. severe hyperchloraemia. severe hyperkalaemia. severe hypernatraemia

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Cautions

Cardiac disease. care should be taken to avoid haematocrit concentration from falling below 25-30%. children. renal impairment. severe liver disease. surgery. trauma

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Prescribing And Dispensing Information

Hydroxyethyl starch is composed of more than 90% of amylopectin that has been etheriﬁed with hydroxyethyl groups; the term tetrastarch reﬂects the degree of etheriﬁcation. Hydroxyethyl starches should only be used for the treatment of hypovolaemia due to acute blood loss when crystalloids alone are not sufﬁcient; they should be used at the lowest effective dose for the ﬁrst 24 hours of ﬂuid resuscitation. Volulyte ® contains hydroxyethyl starch 6% (average molecular weight 130 000) in sodium chloride intravenous infusion 0.6%, containing Na+ 137 mmol, K+ 4 mmol, Mg2+ 1.5 mmol, Cl- 110 mmol, acetate 34 mmol/litre.

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Safety

Side Effects

▶Common or very common Pruritus ▶Rare or very rare Coagulation disorder. hypersensitivity

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Hepatic Impairment

Manufacturer advises caution in mild to moderate impairment; avoid in severe impairment.

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Renal Impairment

Avoid.

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Monitoring Requirements

▶Plasma and plasma substitutes are often used in very ill patients whose condition is unstable. Therefore, close monitoring is required and ﬂuid and electrolyte therapy should be adjusted according to the patient’s condition at all times. Treatment with hydroxyethyl starches should be guided by continuous haemodynamic monitoring so that the infusion is stopped as soon as appropriate haemodynamic goals have been achieved. ▶Monitor renal function. ▶Monitor for hypersensitivity reactions. ▶Urine output should be monitored.

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Dose and formulations

Medicinal Forms

There can be variation in the licensing of different medicines containing the same drug. Infusion ▶Volulyte (Fresenius Kabi Ltd) A Magnesium chloride hexahydrate 300 mg per 1 litre, Potassium chloride 300 mg per 1 litre, Sodium acetate trihydrate 4.63 gram per 1 litre, Sodium chloride 6.02 gram per 1 litre,Tetrastarch 60 gram per 1 litre Volulyte 6% infusion 500ml Freeflex bags | 15 bag P £229.60 ▶Voluven (Fresenius Kabi Ltd) A Tetrastarch 60 mg per 1 gram Voluven 6% infusion 500ml Freeflex bags | 1 bag P £10.63 Tetrastarch 100 mg per 1 ml Voluven 10% infusion 500ml Freeflex bags | 20 bag P s 1.3 Magnesium imbalance Magnesium imbalance Overview Magnesium is an essential constituent of many enzyme systems, particularly those involved in energy generation; the largest stores are in the skeleton. Magnesium salts are not well absorbed from the gastrointestinal tract, which explains the use of magnesium sulfate p. 1112 as an osmotic laxative. Magnesium is excreted mainly by the kidneys and is therefore retained in renal failure, but signiﬁcant hypermagnesaemia (causing muscle weakness and arrhythmias) is rare. Hypomagnesaemia Since magnesium is secreted in large amounts in the gastro- intestinal ﬂuid, excessive losses in diarrhoea, stoma or ﬁstula are the most common causes of hypomagnesaemia; deﬁciency may also occur in alcoholism or as a result of treatment with certain drugs. Hypomagnesaemia often causes secondary hypocalcaemia, and also hypokalaemia and hyponatraemia. Symptomatic hypomagnesaemia is associated with a deﬁcit of 0.5–1 mmol/kg; up to 160 mmol Mg2+ over up to 5 days may be required to replace the deﬁcit (allowing for urinary losses). Magnesium is given initially by intravenous infusion or by intramuscular injection of magnesium sulfate; the intramuscular injection is painful. Plasma magnesium concentration should be measured to determine the rate and duration of infusion and the dose should be reduced in renal impairment. To prevent recurrence of the deﬁcit, magnesium may be given by mouth, but there is limited evidence of beneﬁt. Magnesium aspartate powder for oral solution below is available as a licensed preparation and, magnesium glycerophosphate tablets and liquid p. 1112 [unlicensed] are available from ‘special-order’ manufacturers or specialist importing companies. Arrhythmias Magnesium sulfate injection has also been recommended for the emergency treatment of serious arrhythmias, especially in the presence of hypokalaemia (when hypomagnesaemia may also be present) and when salvos of rapid ventricular Blood and nutrition tachycardia show the characteristic twisting wave front known as torsade de pointes. Myocardial infarction Limited evidence that magnesium sulfate prevents arrhythmias and reperfusion injury in patients with suspected myocardial infarction has not been conﬁrmed by large studies. Routine use of magnesium sulfate for this purpose is not recommended. Eclampsia and pre-eclampsia Magnesium sulfate injection is the drug of choice for the treatment of seizures and the prevention of recurrent seizures in women with eclampsia. Regimens may vary between hospitals. Calcium gluconate injection p. 1108 is used for the management of magnesium toxicity. Magnesium sulfate injection is also of beneﬁt in women with pre-eclampsia in whom there is concern about developing eclampsia. The patient should be monitored carefully. 1.3a Hypomagnesaemia ELECTROLYTES AND MINERALS › MAGNESIUM

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Dose text by age group

Adult

Initially 10–20 mL, then increased to up to

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1132

Adult

Initially 10–20 mL, then increased to up to

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1132

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.

Drug reference

Tetrastarch

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 1132, 1133

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

PDF page 1132

Contra Indications

PDF page 1132

Cautions

Cardiac disease. care should be taken to avoid haematocrit concentration from falling below 25-30%. children. renal impairment. severe liver disease. surgery. trauma

PDF page 1132

Prescribing And Dispensing Information

PDF page 1133

Safety

Side Effects

▶Common or very common Pruritus ▶Rare or very rare Coagulation disorder. hypersensitivity

PDF page 1132

Hepatic Impairment

Manufacturer advises caution in mild to moderate impairment; avoid in severe impairment.

PDF page 1132

Renal Impairment

Avoid.

PDF page 1132

Monitoring Requirements

PDF page 1133

Dose and formulations

Medicinal Forms

PDF page 1133

Dose text by age group

Adult

Initially 10–20 mL, then increased to up to

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1132

Adult

Initially 10–20 mL, then increased to up to

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1132

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.