히드록시에틸 전분

콜로이드 혈장 증량제

**히드록시에틸 전분(HES)**은 주로 아밀로펙틴으로 구성된 찰옥수수 전분에서 유래한 합성 콜로이드 혈장 증량제입니다. 수의 응급 중환자 치료에서 저혈량증을 치료하고 교질 삼투압을 유지하는 데 사용됩니다. **주요 임상적 특징:** * **혈관 내 지속성:** 정질액(Crystalloid)에 비해 더 우수하고 지속적인 혈관 내 용적 확장 효과를 제공합니다. * **모세혈관 누출 증후군:** 전신 염증 환자에서 혈관 투과성을 감소시키고 전염증성 매개물질을 하향 조절하는 데 도움을 줄 수 있습니다. * **분자량 및 치환도:** 제품은 평균 분자량(MW)과 치환도(DS)에 따라 분류됩니다(예: HES 450/0.7, HES 130/0.4). MW와 DS가 높을수록 혈관 내 반감기가 길어지지만 응고 장애의 위험이 증가합니다.

작용 기전: HES acts as a synthetic colloid to expand plasma volume through oncotic forces. * **Oncotic Pull:** Large HES molecules remain in the intravascular space → **increase plasma oncotic pressure** → draw fluid from the interstitial space into the blood vessels → **expand circulating blood volume**. * **Enzymatic Degradation:** To prevent rapid breakdown, the glucose units of amylopectin are substituted with hydroxyethyl ether groups. * **Metabolism:** Larger molecules are slowly degraded by **serum alpha-amylase** into smaller fragments → fragments < 50,000 Daltons are rapidly excreted by the kidneys.

동물 종별 용량

Cats

Shock bolus (resuscitation) · 5-10 mL/kg · IV · once · Administer slower than in dogs to avoid nausea/vomiting.
Infusion · 1-2 mL/kg/hr; not to exceed 10 mL/kg in a 24 hour period · IV · CRI · 24 hours
Emergent situations / Colloid oncotic pressure support · 10/mL/kg/day · IV · slow bolus over 15-30 minutes OR 24-hour infusion
Shock resuscitation · 20 mL/kg · IV · bolus · Slower in the cat. Rapid administration to cats can cause nausea and vomiting.

Horses

Adult horses - volume support · 8-10 mL/kg/day · IV · daily
Foals - rapid volume support · 3-5 mL/kg · IV · once · In addition to crystalloids.
Hypo-oncotic, well hydrated horses · 0.5-1 mL/kg per hour, up to 10 mL/kg/day · IV · CRI
Volume replacement · 3-10 mL/kg · IV · once · Total daily doses of 10 mL/kg should not be exceeded due to risk for coagulopathies.
Fluid resuscitation and management of hypoproteinemia · 8-10 mL/kg IV bolus or as a CRI at 0.5-1 mL/kg/hr (max. of 10 mL/kg/day) · IV · bolus or CRI

Birds

Volume replacement · 10-15 mL/kg over 20-40 minutes, up to four times daily, OR 10-15 mL/kg bolus over 20-40 minutes followed by 1-2 mL/kg/hr continuous rate infusion · IV · up to q6h or CRI · Recommended maximum dose is 20 mL/kg/24 hours, though author notes exceeding this without side effects.

투여 경로

IVIO

금기

Severe heart failure
Severe bleeding disorders
Oliguric or anuric renal failure

이상반응

Coagulopathies (prolonged PT/PTT, altered Factor VIII and von Willebrand Factor)
Nausea and vomiting (especially in cats if administered too rapidly)
Volume overload leading to pulmonary edema
Hypersensitivity/anaphylactic reactions (rare)
Falsely elevated serum amylase levels
Transient increases in indirect serum bilirubin
Potential risk for acute kidney injury (extrapolated from human data)

약물 상호작용

Whole Blood / Red Blood Cells · Do not administer Hextend simultaneously with blood through the same administration set due to a risk of coagulation.

모니터링

Fluid status (blood pressure, heart rate, capillary refill time, central venous pressure)
Coagulation parameters (PT, PTT, platelet count), especially in high-risk patients or with high doses
Clinical signs of pulmonary edema (respiratory rate/effort, lung auscultation)
Blood gases
Renal function (BUN, creatinine, urine output)

과용량

Overdosage primarily results in **intravascular volume overload**, which can lead to pulmonary edema and congestive heart failure in susceptible patients. Treatment involves stopping the infusion, carefully monitoring fluid status, and administering diuretics (e.g., furosemide) if pulmonary edema develops.

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