Dextran 70

The dosage of Dextran 70 must be carefully individualized by a healthcare provider based on the patient's fluid loss, hemodynamic status (blood pressure and heart rate), and renal function.

• For Acute Shock/Hypovolemia: The standard initial dose for adults is typically 500 mL to 1000 mL administered by intravenous infusion. In emergency situations, the first 500 mL may be infused rapidly, while subsequent volumes should be administered more slowly to prevent circulatory overload.
• Maximum Daily Dose: Total dosage during the first 24 hours should generally not exceed 1.2 grams per kilogram of body weight (approximately 20 mL/kg of a 6% solution). If therapy continues beyond 24 hours, the daily dose should typically not exceed 10 mL/kg.
• Ophthalmic Use: For dry eyes, the usual dosage is 1 to 2 drops in the affected eye(s) as needed throughout the day.

Dextran 70 can be used in children, but extreme caution is required. The total dosage should not exceed the limits based on the child's body weight and clinical state.

• Standard Pediatric Dose: Usually calculated as 10 mL to 20 mL per kilogram of body weight.
• Monitoring: Pediatric patients require much more frequent monitoring of central venous pressure (CVP) and urine output to avoid fluid overload, which can occur more rapidly in smaller patients.

Renal Impairment

In patients with pre-existing kidney disease, Dextran 70 must be used with extreme caution. Because the drug is primarily excreted by the kidneys, impaired function can lead to the accumulation of Dextran, which may cause further renal damage or 'dextran-induced nephrosis.' Healthcare providers may reduce the infusion rate or choose alternative fluids if the patient's creatinine clearance is significantly low.

Hepatic Impairment

While Dextran 70 is not primarily metabolized by the liver, patients with severe hepatic impairment often have underlying coagulation (blood clotting) issues. Since Dextran 70 can interfere with platelet function and clotting factors, these patients must be monitored closely for signs of increased bleeding.

Elderly Patients

Geriatric patients are at a higher risk for congestive heart failure and age-related declines in kidney function. Dosing should be conservative, often starting at the lower end of the range, with continuous monitoring of lung sounds (to check for fluid in the lungs) and urine output.

For systemic use, Dextran 70 is strictly for intravenous (IV) administration. It should never be injected intramuscularly or subcutaneously.

• Administration: It is usually administered through a large-bore IV catheter to allow for rapid infusion if necessary. The solution should be clear; if crystals are present (which can happen if stored in cold temperatures), the bottle may be warmed gently in a water bath until the crystals dissolve.
• Storage: Store at controlled room temperature (15°C to 30°C or 59°F to 86°F). Avoid extreme heat or freezing.

Since Dextran 70 is typically administered in an acute, hospital-based setting for emergency volume expansion, a 'missed dose' in the traditional sense is unlikely. If an infusion is interrupted, the healthcare provider will reassess the patient's fluid status to determine if continuation is necessary.

An overdose of Dextran 70 primarily manifests as circulatory overload (too much fluid in the blood vessels).

• Signs of Overdose: Shortness of breath (dyspnea), coughing, wheezing, rapid heart rate, high blood pressure, and peripheral edema (swelling in the legs or arms).
• Emergency Measures: If overload occurs, the infusion must be stopped immediately. Healthcare providers may administer diuretics (water pills) to help the body eliminate the excess fluid. In severe cases of renal failure or massive overdose, hemodialysis may be required to remove the Dextran molecules from the blood.

> Important: Follow your healthcare provider's dosing instructions. Do not adjust your dose or stop a prescribed treatment without medical guidance.

Because Dextran 70 is an intravenous colloid, side effects are often related to the rapid shift in fluid or the body's immune response to the glucose polymer. Common experiences include:

• Injection Site Reactions: Mild redness, warmth, or swelling at the site where the IV is inserted. This typically resolves shortly after the infusion is completed.
• Nausea and Vomiting: Some patients may feel slightly queasy during or immediately following the infusion. This is usually transient.
• Mild Febrile Reactions: A slight increase in body temperature or feeling of 'flushing' or warmth throughout the body.

• Joint Pain (Arthralgia): Some patients report aching in the joints following administration.
• Urticaria (Hives): A mild allergic skin reaction characterized by itchy, red welts. This often responds well to antihistamines.
• Nasal Congestion: A feeling of 'stuffiness' or pressure in the sinuses.
• Tightness in the Chest: A mild sensation of pressure, which should always be reported to a nurse or doctor immediately to rule out more serious reactions.

• Hypotension (Low Blood Pressure): Paradoxically, while intended to raise blood pressure, an allergic reaction can cause a sudden drop in pressure.
• Dextran-induced Nephrosis: A rare form of acute kidney injury where the Dextran molecules cause swelling in the kidney tubules, potentially leading to a temporary stop in urine production (anuria).
• Priapism: Extremely rare cases of prolonged, painful erections have been reported in the literature following dextran infusions.

> Warning: Stop taking Dextran 70 and call your doctor immediately if you experience any of these.

• Anaphylaxis/Anaphylactoid Reaction: This is the most critical risk associated with Dextran 70. It can occur within the first few minutes of infusion. Symptoms include difficulty breathing, swelling of the face or throat, severe wheezing, and collapse. This is caused by pre-existing dextran-reactive antibodies (DRA) in the patient's blood.
• Pulmonary Edema: Fluid accumulation in the lungs. Symptoms include severe shortness of breath, gasping for air, and coughing up pink, frothy sputum.
• Severe Bleeding: Dextran 70 can interfere with the blood's ability to clot. Watch for unusual bruising, bleeding gums, or blood in the stool or urine.
• Acute Renal Failure: A sudden decrease in urine output, swelling in the ankles, or unexplained fatigue.

Dextran 70 is almost exclusively used for short-term, acute stabilization. Therefore, long-term side effects are rarely documented. However, repeated use over a short period can lead to:

• Prolonged Coagulopathy: Extended interference with blood clotting factors (specifically Factor VIII and von Willebrand factor), which may increase the risk of bleeding for several days after the last dose.
• Persistent Renal Stress: In patients with borderline kidney function, the osmotic load of Dextran may cause lingering elevations in serum creatinine levels.

No FDA black box warnings currently exist for Dextran 70. However, the risk of severe anaphylactoid reactions is a well-known clinical warning that requires the presence of resuscitative equipment and trained personnel during the initiation of the infusion.

Report any unusual symptoms to your healthcare provider. If you are using the ophthalmic version and experience eye pain, changes in vision, or continued redness, discontinue use and consult an eye specialist.

Dextran 70 is a potent clinical agent that must be used with caution. The most significant risk is the potential for severe, life-threatening allergic reactions, even in patients who have never received Dextran before. This occurs because some individuals naturally possess antibodies that cross-react with the Dextran molecule. Because of this, the first few milliliters of any Dextran 70 infusion must be administered very slowly while the patient is under constant medical observation.

No FDA black box warnings for Dextran 70. However, clinicians should treat the risk of anaphylaxis with the same level of gravity as a boxed warning.

• Allergic Reactions / Anaphylaxis Risk: Severe reactions (Grade III or IV) can occur. Healthcare providers often monitor for signs like sudden hypotension, tachycardia (fast heart rate), or bronchospasm (narrowing of the airways). Some protocols suggest the use of Dextran 1 (Promit) as a pre-treatment to bind these antibodies and prevent a reaction, though this is not universal.
• Fluid Overload: Because Dextran 70 pulls fluid into the blood vessels, it can easily cause 'volume overload.' This is particularly dangerous for patients with pre-existing heart disease or high blood pressure. It can lead to heart failure or pulmonary edema.
• Renal Toxicity: Dextran 70 can increase the viscosity of urine, which may lead to 'osmotic nephrosis.' Patients must be well-hydrated before and during administration to ensure the kidneys can flush the Dextran molecules out effectively.
• Bleeding Risk: Dextran 70 acts as a mild anticoagulant. It reduces platelet adhesiveness and can lower the levels of certain clotting factors. This can lead to increased surgical bleeding or spontaneous bruising.
• Interference with Blood Cross-matching: Dextran 70 can cause 'pseudoagglutination' (false clumping) of red blood cells. This can make it difficult or impossible to accurately determine a patient's blood type or cross-match blood for a transfusion. Crucially, blood samples for typing and cross-matching MUST be drawn BEFORE the Dextran infusion begins.

Patients receiving Dextran 70 require intensive monitoring, typically in an ICU or emergency department setting:

• Hemodynamic Monitoring: Frequent checks of blood pressure, heart rate, and central venous pressure (CVP).
• Urine Output: Monitoring the volume of urine produced every hour to ensure the kidneys are functioning.
• Laboratory Tests: Regular checks of hematocrit (to ensure the blood hasn't become too diluted), electrolytes, and kidney function tests (BUN and Creatinine).
• Coagulation Profiles: Monitoring Prothrombin Time (PT) and Partial Thromboplastin Time (PTT).

Since Dextran 70 is used in emergency or surgical settings, patients will not be in a condition to drive or operate machinery. For ophthalmic use, the drops may cause temporary blurred vision; patients should wait until their vision clears before driving.

There are no direct chemical interactions between Dextran 70 and alcohol. However, alcohol can cause dehydration and affect blood pressure, both of which can complicate the management of the conditions Dextran 70 is used to treat. Alcohol should be avoided during recovery from shock or major surgery.

Dextran 70 does not require a tapering period. Once the patient's blood volume is stabilized and they can transition to oral fluids or other IV maintenance fluids, the Dextran infusion is simply stopped.

> Important: Discuss all your medical conditions with your healthcare provider before starting Dextran 70.

There are few 'absolute' drug-drug contraindications for Dextran 70 because it is a polysaccharide used in emergencies. However, its use is generally avoided alongside other high-molecular-weight colloids (like certain starches) due to the additive risk of renal failure and fluid overload.

• Anticoagulants (Warfarin, Heparin, Enoxaparin): Dextran 70 has its own anti-clotting effects. Combining it with medical anticoagulants significantly increases the risk of major internal or surgical bleeding. The mechanism involves an additive effect on platelet inhibition and fibrin structure.
• Antiplatelet Agents (Aspirin, Clopidogrel, Ticagrelor): Since Dextran 70 coats platelets and reduces their ability to stick together, using it with aspirin or other antiplatelet drugs can lead to prolonged bleeding times.
• Nephrotoxic Drugs (Aminoglycosides, Amphotericin B, Vancomycin): Because Dextran 70 can stress the kidneys, using it alongside other drugs known to cause kidney damage increases the risk of acute renal failure. The mechanism is a synergistic toxic effect on the renal tubules.

• Diuretics (Furosemide, Hydrochlorothiazide): Diuretics can cause dehydration. If a patient is dehydrated, Dextran 70 is more likely to cause kidney damage. However, diuretics are sometimes used intentionally to treat the fluid overload caused by Dextran.
• NSAIDs (Ibuprofen, Naproxen): These drugs can affect kidney blood flow and platelet function, potentially worsening the side effects of Dextran 70.

There are no known interactions between Dextran 70 and specific foods. However, general nutritional status is important; patients with severe protein malnutrition may react differently to the oncotic pressure changes induced by Dextran.

Patients should be cautious with supplements that have blood-thinning properties, such as:

• Ginkgo Biloba
• Garlic (high doses)
• Vitamin E
• Omega-3 Fatty Acids (Fish Oil)

These may theoretically increase the bleeding risk when Dextran 70 is administered.

Dextran 70 is notorious for interfering with various laboratory tests:

• Blood Typing and Cross-matching: As mentioned, it causes pseudoagglutination of red cells. This is a physical interaction where the Dextran molecules act like a 'glue.'
• Blood Glucose Tests: Dextran is a glucose polymer. Some older laboratory methods that use strong acids to hydrolyze samples may break Dextran down into glucose, leading to falsely elevated blood sugar readings.
• Serum Protein Tests: Dextran can interfere with the Biuret reagent used to measure total protein, leading to inaccurate results.
• Bilirubin and Cholesterol Tests: High concentrations of Dextran in the blood can cause turbidity (cloudiness) in serum samples, which interferes with many light-based (colorimetric) laboratory assays.

> Important: Tell your doctor about ALL medications, supplements, and herbal products you are taking.

Dextran 70 must NEVER be used in the following circumstances:

• Known Hypersensitivity to Dextran: Any previous allergic reaction to Dextran products is a strict contraindication due to the risk of fatal anaphylaxis.
• Severe Renal Failure with Oliguria or Anuria: If the kidneys are not producing urine, they cannot excrete Dextran. This leads to rapid accumulation and toxic levels of the drug.
• Severe Congestive Heart Failure: Patients whose hearts cannot pump effectively are at extreme risk of pulmonary edema (fluid in the lungs) if their blood volume is rapidly expanded by Dextran 70.
• Known Hemorrhagic Disorders: Conditions like severe thrombocytopenia (low platelets) or hypofibrinogenemia (low clotting protein) are contraindications because Dextran 70 will further impair the blood's ability to clot, potentially leading to uncontrollable bleeding.

Conditions requiring careful risk-benefit analysis include:

• Active Bleeding: While used for shock, if the bleeding is not yet controlled, Dextran 70 might increase the rate of blood loss by 'thinning' the blood and increasing blood pressure.
• Dehydration: Dextran 70 pulls water from the tissues. In a severely dehydrated patient, this can further 'dry out' the cells and damage the kidneys. Dehydration should be corrected with crystalloids (like Saline) before or alongside Dextran use.
• Chronic Liver Disease: Due to the pre-existing risk of bleeding and fluid regulation issues (like ascites).

There is no known cross-sensitivity between Dextran 70 and other non-dextran plasma expanders like albumin or gelatin-based solutions. However, patients who react to Dextran 70 will almost certainly react to Dextran 40, as they share the same basic polysaccharide structure.

> Important: Your healthcare provider will evaluate your complete medical history before prescribing Dextran 70.

FDA Pregnancy Category C. There are no adequate and well-controlled studies of Dextran 70 in pregnant women. Animal reproduction studies have not been conducted.

• Risks: The primary concern during pregnancy is the risk of an anaphylactoid reaction in the mother. Such a reaction can cause severe maternal hypotension, which leads to fetal hypoxia (lack of oxygen to the baby) and potential neurological damage or fetal death.
• Clinical Use: Dextran 70 should be given to a pregnant woman only if clearly needed and if the potential benefit justifies the risk to the fetus. It is generally avoided during labor and delivery unless no other volume expanders are available.

It is not known whether Dextran 70 is excreted in human milk. However, because Dextran 70 is a large polysaccharide similar to naturally occurring carbohydrates and is used acutely, it is unlikely to pose a significant risk to a nursing infant. Most healthcare providers consider it compatible with breastfeeding, though the underlying condition requiring Dextran (e.g., major surgery or trauma) may necessitate a temporary pause in breastfeeding.

Dextran 70 is used in pediatric patients for the same indications as adults. However, children have a much smaller total blood volume, making them extremely sensitive to volume expansion.

• Safety: The risk of fluid overload and congestive heart failure is higher in infants.
• Monitoring: Continuous monitoring of heart rate and respiratory rate is mandatory during infusion in children.

Elderly patients (over 65) often have reduced cardiac reserve and decreased renal clearance.

• Fall Risk: Not directly applicable as the drug is used in acute settings, but the recovery period may involve dizziness or blood pressure fluctuations.
• Dosing: Lower infusion rates are generally recommended. Older patients are at the highest risk for 'dextran-induced nephrosis' and must be monitored for any drop in urine output.

In patients with a GFR (Glomerular Filtration Rate) below 30 mL/min, Dextran 70 is generally avoided. If it must be used, the dose should be reduced, and the patient may require 'forced diuresis' (using drugs like furosemide) to ensure the Dextran is cleared from the kidneys. Dextran 70 is not efficiently removed by peritoneal dialysis, but some clearance may occur during hemodialysis.

No specific dose adjustments are required based on Child-Pugh classification, but the healthcare provider must be vigilant regarding the patient's coagulation status. Liver failure often results in low albumin levels, which might change how the body responds to the oncotic pressure of Dextran.

> Important: Special populations require individualized medical assessment.

Dextran 70 is a branched-chain polysaccharide that acts as a hyperoncotic colloid. Its molecular weight of 70,000 Daltons prevents it from passing through the capillary pores into the interstitial space. By remaining in the intravascular compartment, it creates an osmotic gradient that pulls water from the extravascular space into the blood vessels. This increases the plasma volume, which in turn increases venous return, stroke volume, and cardiac output. Additionally, Dextran 70 coats the surface of red blood cells and platelets, increasing their negative surface charge (zeta potential), which reduces red cell aggregation and improves blood flow through the microvasculature.

• Onset of Action: The volume expansion effect is almost immediate upon starting the IV infusion.
• Duration of Effect: The plasma-expanding effect typically lasts for 12 to 24 hours, depending on the patient's renal function and the rate at which the larger molecules are broken down.
• Tolerance: There is no known tolerance development to the osmotic effects of Dextran 70.

| Parameter | Value |

|---|---|

| Bioavailability | 100% (IV) |

| Protein Binding | Minimal (interacts with clotting factors) |

| Half-life | 20-25 hours |

| Tmax | Immediate (IV) |

| Metabolism | Dextranase (to glucose/CO2) |

| Excretion | Renal 40-50% (24h), Fecal <1% |

• Molecular Formula: (C6H10O5)n
• Molecular Weight: Average ~70,000 Daltons
• Solubility: Freely soluble in water; insoluble in alcohol.
• Structure: A polymer of glucose units with alpha-1,6-linkages in the main chain and alpha-1,3-linkages at the branch points.

Dextran 70 is classified as a Plasma Volume Expander [EPC] and a Colloid. Related medications include Dextran 40 (Lower molecular weight), Hydroxyethyl Starch (HES), and Human Albumin.