Hydroxyethyl starch, Potassium chloride, Calcium chloride, Xylitol, Magnesium chloride, Sodium lactate, Sodium chloride

Pharmacological properties

The main active ingredients in the preparation are hydroxyethyl starch (hex) 130/04, xylitol and sodium lactate. geckoton has hemodynamic, rheological, anti-shock, detoxification effects.

HES is an artificial colloid obtained from amylopectin. The structure is similar to glycogen, which determines its good tolerance and low risk of anaphylactic reactions. After intravenous administration as a result of hydrolysis of HES with serum amylase, smaller molecules are formed that are oncotically active until they are excreted by the kidneys. HES has the ability to accumulate in the cells of the reticuloendothelial system, but does not have a toxic effect on the liver, lungs, spleen, and lymph nodes. Introduction HES restores impaired hemodynamics, improves microcirculation and rheological properties of blood (by reducing hematocrit), reduces blood viscosity, reduces platelet aggregation and prevents red blood cell aggregation. With the use of HES in patients with hypovolemia, BCC increases and geodynamic and cardiac functions improve. When applying an adequate amount of HES, the normal blood volume is maintained for at least 6 hours.

Xylitol is a five-atom alcohol that, when introduced, is quickly incorporated into the general metabolism, 80% of which is absorbed by the liver and accumulates in the form of glycogen, the rest of the xylitol is absorbed by the tissues of other organs (kidneys, heart, pancreas, adrenal glands, brain) and excreted in the urine. The product of carbohydrate metabolism - xylitol - is pentitol and is directly involved in the pentose phosphate cycle of metabolism. Xylitol, unlike fructose and sorbitol, does not cause adenine nucleotide reduction (ATP, ADP, AMP) in the liver, it is safe for administration to patients with increased sensitivity to fructose or with a deficiency of the enzyme fructose-1,6-diphosphatase. Xylitol is believed to have a higher antiketogenic, nitrogen-saving effect than glucose, and is equally well absorbed both in the pre- and postoperative period. Considering that xylitol is an energy source with an insulin-independent metabolism, acts antiketogenically and lipotropically, it is recommended for use as a means of parenteral nutrition for patients, especially those who underwent gastrointestinal surgery. The maximum rate of xylitol utilization is 0.25 g / kg / h.

Sodium lactate is a delayed alkaline agent. When sodium lactate is introduced into the vascular bed, sodium is released.₂ and H₂O, which form sodium bicarbonate, which leads to an increase in the alkaline reserve of blood. Correction of metabolic acidosis with sodium lactate occurs slowly (as sodium lactate is included in the metabolism), but does not cause sharp pH fluctuations. It is believed that sodium lactate has a positive effect on cardiac activity, as well as the regeneration and respiratory function of the blood, has a detoxifying effect, helps increase urine output, improves liver and kidney function. The action of sodium lactate is manifested 20-30 minutes after administration.

Due to its composition, Hekoton belongs to the group of multicomponent colloid-hyperosmolar solutions. After the drug is injected into a vein, the osmotic pressure of the blood rises, the evacuation of fluid from the tissues to the vascular bed is enhanced, impaired hemodynamics is restored, microcirculation and rheological properties of the blood are improved, cardiac activity is enhanced, the metabolic process is increased, and detoxification function of the liver is improved.

Indications

Prevention and treatment of hypovolemia and shock due to surgical interventions, infectious diseases, injuries and burns; therapeutic blood dilution (hemodilution) for therapeutic purposes.

Application

The drug is administered intravenously.

Due to possible anaphylactoid reactions, the first 10–20 ml of the drug should be administered slowly, at a rate of 20–30 drops in 1 min, under the supervision of a physician.

Dosage recommendations for blood volume replacement. The daily dose and rate of infusion depend on the volume of blood loss and the hematocrit index.

The risk of overload of the circulatory system should be taken into account with the introduction of too fast and too high a dose. In patients without a risk of cardiovascular or pulmonary complications, a hematocrit value of 30% is the limit for the introduction of colloidal volume-replacing agents.

In emergency cases, the maximum infusion rate of the drug can be 10 ml / kg / h (350-400 ml / 30 min). The recommended speed is 5 ml / kg / h (350-400 ml / h).

The maximum daily dose (in exceptional cases, excess is allowed) is 20 ml / kg / day (1400–1600 ml / day). Usually, 5–10 ml / kg / day (400–800 ml / day) is infused.

The duration and level of therapeutic use is determined by the duration and level of hypovolemia.

Dosing recommendations for therapeutic dilution of blood for therapeutic purposes (hemodilution). The recommended speed is 1.5–3 ml / kg / h (100–200 ml / h), depending on the dose. With an increase in the daily dose, the rate of administration is recommended to be reduced.

Recommended Dosage:

• high dose - 2 times 400-500 ml / day (10-15 ml / kg / day);
• the average dose is 400 ml / day (6 ml / kg / day);
• low dose - 200 ml / day (3 ml / kg / day).

If the drug is used for hemodilution for several consecutive days, the total dose should not exceed 5 l, while the dose can be divided into a period of up to 4 weeks.

Contraindications

Hypersensitivity to active substances (including an allergy to starch), a state of hyperhydration, hypervolemia, renal failure, accompanied by oliguria or anuria (creatinine 177 μmol / L), hyperosmolar coma, hyperlactatemia (lactic acidosis), coagulopathy, severe hypoglycemia severe thrombocytopenia, the period of hemodialysis sessions. gecotone should not be administered in cases where fluid infusion is contraindicated (edema, intracranial hemorrhage, stage III hypertension). special caution is recommended for patients with pulmonary edema, cardiovascular decompensation, severe chronic liver diseases, dehydration (in this case, it is recommended to carry out fluid replacement with crystalloids).

Side effects

Rarely, with the introduction of gecotone, the onset of symptoms characteristic of the use of geck can be predicted.

On the part of the immune system: anaphylactoid reactions of varying severity (skin reactions, sudden rush of blood to the face, tachycardia, dizziness, vomiting, fever), which can lead to a decrease in blood pressure, bronchospasm. Severe intolerance reactions, accompanied by shock, pulmonary edema, cardiac arrest and breathing, are very rare. Perhaps an increase in the submandibular and parotid salivary glands, the appearance of flu-like symptoms, headache and muscle pain. In the event of intolerance reactions, the administration of the drug should be stopped immediately and emergency measures should be taken, depending on the clinical symptoms and severity, antihistamines, GCS should be prescribed.

On the part of the skin and subcutaneous tissue: prolonged daily use of the drug in medium and high doses can cause itching of the skin, which is difficult to treat and can last for months. In this case, it is recommended that the maximum daily dose be reduced to 200 ml.

From the urinary system: sometimes lower back pain can occur (the use of the drug should be discontinued, it is necessary to ensure the introduction of a large number of physiological electrolyte solutions and frequent monitoring of blood plasma creatinine).

Laboratory indicators: when using the drug, the level of blood amylase may increase, which returns to normal within 3-5 days (diagnostic or therapeutic measures are not carried out).

On the part of the blood system and lymphatic system: with the rapid administration or administration of a significant amount of the drug, a sharp increase in the BCC is possible.

Vascular disorders: when the drug is administered in high doses, symptoms of increased bleeding (liquefaction effect) and prolonged blood coagulation may occur. Therefore, do not use doses that exceed the maximum recommended.

General disorders and condition at the injection site: the use of Hekoton can rarely also cause symptoms characteristic of the side effects of xylitol: nausea, bloating, diarrhea, abdominal pain. Hekoton, like other hypertonic and hyperosmolar solutions, with prolonged administration can cause irritation of peripheral veins at the injection site.

special instructions

The drug is used with caution in compensated heart failure, pulmonary edema, chronic renal failure, severe chronic liver disease, von Willebrand disease, hemorrhagic diathesis. during the administration of the drug, it is necessary to ensure sufficient hydration of the body, to control the water-electrolyte balance and renal function. when using the drug, blood amylase concentration may increase, which may interfere with the diagnosis of pancreatitis. the use of the drug can also affect laboratory blood parameters such as blood glucose, protein and ESR, as well as change laboratory parameters of urine analysis. for liver diseases, the drug is used under the control of liver function indicators. since xylitol has choleretic properties, the introduction of gecotone in gallstone disease should be carried out under the supervision of a physician. administration of the drug to patients with diabetes mellitus must be carried out under the control of glucose in the blood.

Use during pregnancy and lactation. There is no experience with the use of the drug during pregnancy and lactation.

Children. There is no experience with the use of the drug in children.

The ability to influence the reaction rate when driving or working with other mechanisms. The drug is used only in a hospital setting.

Interactions

The drug should not be mixed with phosphate and carbonate-containing solutions. gecotone cannot be a carrier solution for other drugs. the addition of drugs can lead to physico-chemical changes in the solution.

With simultaneous use with aminoglycoside antibiotics, HES is able to potentiate their nephrotoxicity.

When using other drugs containing HES, it should be borne in mind that the total maximum daily dose of HES should not exceed 2 g / kg / day.

When using other drugs containing xylitol or other carbohydrates (glucose, sorbitol, fructose, etc.), the total daily dose of carbohydrates should not exceed 2 g / kg / day.

Overdose

The use of the drug in high doses due to the effects of dilution and overload of the circulatory system with a volume of fluid can cause a prolongation of bleeding time, which does not affect platelet function and does not lead to clinically significant bleeding. attention should be paid to a possible decrease in hematocrit and a decrease in the concentration of proteins in blood plasma. In addition, alkalosis, nausea, bloating, diarrhea, and abdominal pain may occur.

Storage conditions

At a temperature not exceeding 25 ° C. do not freeze.