BNF for Children 2011-2012

BNFC 2011–2012 9.2.2 Parenteral preparations for fluid & electrolyte imbalance 465Plasma substitutesGelatin and the etherified starches (pentastarch andtetrastarch) are macromolecular substances which aremetabolised slowly; they may be used at the outset toexpand and maintain blood volume in shock arisingfrom conditions such as burns or septicaemia. Plasmasubstitutes may be used as an immediate short-termmeasure to treat haemorrhage until blood is available.They are rarely needed when shock is due to sodiumand water depletion because, in these circumstances,the shock responds to water and electrolyte repletion;see also section 2.7.1 for the management of shock.Plasma substitutes should not be used to maintainplasma volume in conditions such as burns or peritonitiswhere there is loss of plasma protein, water, and electrolytesover periods of several days or weeks. In thesesituations, plasma or plasma protein fractions containinglarge amounts of albumin should be given.Large volumes of some plasma substitutes can increasethe risk of bleeding through depletion of coagulationfactors.Plasma and plasma substitutes are often used in veryill children whose condition is unstable. Therefore,close monitoring is required and fluid and electrolytetherapy should be adjusted according to the child’scondition at all times.The use of plasma substitutes in children requiresspecialist supervision due to the risk of fluid overload;use is best restricted to an intensive caresetting.Cautions Plasma substitutes should be used withcaution in cardiac disease, liver disease, or renal impairment;urine output should be monitored. Care should betaken to avoid haematocrit concentration from fallingbelow 25–30% and the child should be monitored forhypersensitivity reactions.Side-effects Hypersensitivity reactions may occurincluding, rarely, severe anaphylactic reactions. Transientincrease in bleeding time may occur.GELATINNote The gelatin is partially degradedCautions see notes abovePregnancy manufacturer of Geloplasma c advisesavoid at the end of pregnancySide-effects see notes aboveIndication and doseLow blood volume in hypovolaemic shock,burns and cardiopulmonary bypass. By intravenous infusionInitially 10–20 mL/kg of a 3.5–4% solution (seenotes above)Gelofusine c (Braun) AIntravenous infusion, succinylated gelatin (modifiedfluid gelatin, average molecular weight 30 000) 40 g(4%), Na + 154 mmol, Cl 124 mmol/litre, net price500-mL Ecobag c = £5.15; 1-litre Ecobag c = £9.67Contains traces of calciumGeloplasma c (Fresenius Kabi) AIntravenous infusion, partially hydrolysed and succinylatedgelatin (modified liquid gelatin) (as anhydrousgelatin) 30 g (3%), Na + 150 mmol, K + 5 mmol,Mg 2þ 1.5 mmol, Cl 100 mmol, lactate 30 mmol/litre,net price 500-mL bag = £5.05Isoplex c (Beacon) AIntravenous infusion, succinylated gelatin (modifiedfluid gelatin, average molecular weight 30 000) 40 g(4%), Na + 145 mmol, K + 4 mmol, Mg 2þ 0.9 mmol, Cl105 mmol, lactate 25 mmol/litre, net price 500-mLbag = £7.53; 1-litre bag = £14.54Volplex c (Beacon) AIntravenous infusion, succinylated gelatin (modifiedfluid gelatin, average molecular weight 30 000) 40 g(4%), Na + 154 mmol, Cl 125 mmol/litre, net price500-mL bag = £4.70; 1-litre bag = £9.09ETHERIFIED STARCHA starch composed of more than 90% of amylopectinthat has been etherified with hydroxyethyl groups; theterms tetrastarch and pentastarch reflect the degreeof etherificationCautions see notes aboveRenal impairment use with caution in mild to moderateimpairment; avoid in severe impairmentSide-effects see notes above; also pruritus, raisedserum amylaseIndication and doseLow blood volume. By intravenous infusionAccording to the child’s condition (see notesabove)PentastarchHAES-steril c (Fresenius Kabi) AIntravenous infusion, pentastarch (weight averagemolecular weight 200 000) 10% in sodium chlorideintravenous infusion 0.9%, net price, 500 mL = £16.50Hemohes c (Braun) AIntravenous infusion, pentastarch (weight averagemolecular weight 200 000), net price (both in sodiumchloride intravenous infusion 0.9%) 6%, 500 mL =£12.50; 10%, 500 mL = £16.50TetrastarchTetraspan c (Braun) AIntravenous infusion, hydroxyethyl starch (weightaverage molecular weight 130 000) 6% in sodiumchloride 0.625%, containing Na + 140 mmol, K +4 mmol, Mg 2þ 1 mmol, Cl 118 mmol, Ca 2þ 2.5 mmol,acetate 24 mmol, malate 5 mmol/litre, net price 500-mL bag = £13.50Volulyte c (Fresenius Kabi) AIntravenous infusion, hydroxyethyl starch (weightaverage molecular weight 130 000) 6% in sodiumchloride intravenous infusion 0.6%, containing Na +137 mmol, K + 4 mmol, Mg 2þ 1.5 mmol, Cl 110 mmol,acetate 34 mmol/litre, net price 500-mL bag = £13.509 Nutrition and blood