Rapid emergency treatment of shock: hypovolemic shock resulting from conditions such as: haemorrhage, dehydration, capillary leakage, burns; vascular shock of traumatic, surgical, infectious or toxic origin. Treatment of relative hypotension induced by antihypertensive drugs in the vasodilation mechanism, particularly during anesthesia.
Composition:
100 ml of the solution contain 0.54 g of sodium chloride, 0.03 g of Magnesium chloride hexahydrate, 0.04 g of potassium chloride, 0.34 g of sodium lactate and 3 g of gelatine (in the form of a modified liquid gelatin). The product contains 0.06% succinic acid. Total osmolality: 295 mOsmol / kg. pH: 5.8 to 7.0. Ion content: sodium 150 mmol / l; Potassium 5 mmol / L; magnesium 1.5 mmol / l; chloride 100 mmol / l; lactol 30 mmol / l.
Action:
Modified liquid gelatin in an ionic solution similar to extracellular fluid, used for vascular filling and restoration of water and electrolyte balance. The preparation is involved in the alleviation of acidosis. The solution makes it possible to restore the volume of blood, equimolarly, without increasing the volume of the plasma due to penetration of the interstitial fluid into the vessels; hemodilution with decreased blood viscosity and improved microcirculation; rehydration of extravascular space. Liquid gelatin also slightly increases urination. The preparation does not interfere with the determination of the blood group and does not affect the coagulation mechanisms. Liquid gelatin can be used separately without the need for transfusion, to compensate for blood loss 10 to 20% of the total volume, and instead of blood for any infusion of limited volume (about 500 ml). In the case of large bleeding, alternate administration of blood and liquid gelatin provides adequate hemodilution (restoration of blood volume and maintenance of oncotic pressure). The distribution and excretion of modified liquid gelatin given by intravenous infusion depends on many factors: particle size, molecular weight, electric charge, volume, rate of administration, etc. The presence of low molecular weight substances explains the effect on the kidneys and increased urinary excretion. A solution of modified liquid gelatin provides effective vascular bed filling for four to five hours after infusion. Modified liquid gelatin is excreted rapidly (75% in 24 hours), mainly by the kidneys.
Contraindications:
Known or suspected hypersensitivity to gelatin solutions. A predominantly extracellular presumption. Hyperkalemia. Metabolic alkalosis. End of pregnancy (during delivery). Do not give intramuscularly.
Precautions:
Due to the possibility of allergic reactions (anaphylactic or anaphylactoid), proper monitoring of the patient's condition is necessary. If an allergic reaction occurs, the infusion must be discontinued immediately and appropriate treatment should be given. It must not be administered with transfused blood or blood products (platelet concentrate, plasma or plasma fractions) through the same infusion set. After completion of the infusion of the preparation (up to 2 liters of liquid gelatin), blood group, non-standard antigens and any laboratory blood tests can be performed. Nevertheless, it is recommended to take blood samples before commencing the infusion of the preparation, in order to avoid impeding interpretation of the results. It is necessary to monitor: blood pressure (if possible, pressure in the vena cava), urination, hematocrit and electrolytes - especially in patients with congestive heart failure, circulatory overload, impaired lung function, severe renal impairment, edema with water retention and salts treated with corticosteroids and their derivatives, severe clotting disorder. Hematocrit values should not fall below 25%, and below 30% in the elderly. The coagulation disorders caused by dilution of coagulation factors should be avoided. If more than 2 to 3 liters of the preparation have been administered before or during surgery, it is recommended to check plasma protein concentration, especially if signs of tissue edema are present.The preparation may cause metabolic alkalosis because it contains lactate ions; may not alkalizing in patients with hepatic impairment due to the possibility of lactate metabolism disturbance. The medicine contains 5 mmol of potassium and 150 mmol of sodium per liter. This information should be included in patients with reduced renal function or those controlling the sodium and potassium content of the diet.
Pregnancy and lactation:
The drug must not be administered to pregnant women at the end of pregnancy due to the possibility of allergic reactions with subsequent fetal or neonatal, secondary to hypotension in the mother. In another period of pregnancy, the preparation should only be administered if the expected benefit outweighs the possible risk to the fetus. The drug should not be used to prevent hypovolemia during labor with general anesthesia or epidural anesthesia; however, it can be used to treat hypovolemia when plasma replacement preparations are needed during pregnancy. There are no data on the use of the drug during lactation.
Side effects:
Rare: anaphylactic shock, allergic skin reactions. Very rare: hypotension, slow heart rate, difficulty in breathing, fever, chills.
Dosage:
Intravenously infused. The dose and speed of administration depends on the patient's needs and condition, volume of blood replacement and hemodynamic efficiency of the patient. The average dose administered is from 500 to 1000 ml, in some cases more. In adults and children weighing more than 25 kg, 500 ml are administered at a rate depending on the patient's condition. The infusion rate can be increased if you experience severe hemorrhage. In the event of a blood loss or fluids greater than 1.5 liters in an adult (i.e., more than 20% of the blood volume), both the preparation and the blood should normally be administered. Haemodynamic, haematological and coagulation parameters should be monitored. The infusion rate can be increased by using a pump.
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