Reosorbilact

Pharmacological properties

Plasma substituting solution. rheosorbilact has a rheological, anti-shock, detoxification effect, eliminates acidosis. The main pharmacologically active substances of the drug are sorbitol and sodium lactate. when sodium lactate is introduced into the vascular bed, sodium, co2 and H2o are released, forming sodium bicarbonate, which leads to an increase in the alkaline reserve of blood. in contrast to the bicarbonate solution, the correction of metabolic acidosis when using sodium lactate comes gradually as it is included in the metabolism; however, there are no sharp fluctuations in pH. only 50% of the injected sodium lactate (l-isomer) exhibits pharmacological activity, the second half of the drug (d-isomer) is not metabolized and excreted in the urine. the effect of sodium lactate is manifested 20-30 minutes after administration. Sorbitol is rapidly involved in metabolism, 80–90% of it is utilized in the liver and accumulates as glycogen. in the liver, sorbitol is first converted to fructose, which is subsequently transformed into glucose, and then into glycogen. part of sorbitol is consumed for emergency energy needs, the rest is deposited in the form of glycogen. the isotonic sorbitol solution has a disaggregant effect and thus improves microcirculation and tissue perfusion.

Indications

For detoxification, microcirculation improvement, core correction, hemodynamic improvement in case of traumatic, surgical, hemolytic and burn shock, acute blood loss, burn disease, protracted purulent processes, infectious diseases, chronic hepatitis, for preoperative preparation and in the postoperative period, for obliterating blood diseases vessels.

Application

In / in a stream or drip. in case of traumatic, burn, postoperative, hemolytic shock, 600–1000 ml (10-15 ml per 1 kg of the patient’s body weight), first jet, then drip; if necessary, re-enter. in chronic hepatitis, 400 ml (6–7 ml per 1 kg of body weight) are administered dropwise, and again in acute blood loss, 1500–1800 ml (up to 25 ml per 1 kg of body weight). in the preoperative period and after surgical interventions at a dose of 400 ml (6-7 ml per 1 kg of body weight) drip, once or repeatedly daily for 3-5 days. in case of obliterating diseases of blood vessels, they are administered at the rate of 8-10 ml per 1 kg of body weight, in / in drip every other day; for the course of treatment - 10 infusions.

Contraindications

Alkalosis, conditions in which the introduction of fluid is limited (stroke, thromboembolism, decompensated heart failure, hypertension stage III).

Side effects

Alkalosis.

special instructions

The drug is prescribed under the control of indicators of core and liver function.

Interactions

Do not mix with phosphate and carbonate solutions.

Overdose

Manifested by alkalosis; drug administration is stopped immediately.

Storage conditions

In a dry, dark place at a temperature of 2-24 ° C.

Actual information

Reosorbilact is a popular Ukrainian drug for iv administration, which has found wide application in the practice of almost all specialties. despite the simplicity of the composition, its components are included in many metabolic processes in the body of a sick person, allowing you to quickly adjust homeostasis.

Composition and chemical properties

Reosorbilact is a ready crystalloid solution with plasma substituting and detoxifying properties. This is a clear solution, the theoretical osmolarity of which is 891 mOsmol / L, and the pH is in the range of 6.00– 7.60. Such characteristics are provided by its constituent components: sorbitol (60.0 mg / ml), sodium lactate (19.0 mg / ml), sodium chloride (6.0 mg / ml), calcium chloride dihydrate (0.1 mg / ml), potassium chloride (0.3 mg / ml), magnesium chloride hexahydrate (0.2 mg / ml).Water for injection acts as a solvent (instruction of the Ministry of Health of Ukraine). The drug for the convenience of dose selection is available in vials for intravenous administration in a volume of 200 or 400 ml.

Pharmacodynamics and pharmacokinetics

The action of Reosorbilact is realized mainly due to sorbitol and sodium lactate. Sorbitol refers to polyhydric alcohols and is known in the food industry as a sweetener. But he has a large number of effects used in medicine. Sorbitol due to its moisture retention properties has a positive effect on the gastrointestinal tract as an osmotic laxative. In addition, being a stereoisomer of mannitol (an osmotic diuretic), it has a choleretic, diuretic and general detoxifying effect. Sorbitol is also an alternative source of energy - its energy value is 354 kcal per 100 g. It does not apply to carbohydrates, which allows it to be used for nutritional support of patients with diabetes without adjusting the dosage of insulin. Isotonic solution of sorbitol positively affects capillary blood flow, improving the rheological properties of blood.

Sodium lactate is today considered the most relevant tool for the correction of homeostasis due to several advantages. Firstly, it is an alternative source of energy and is actively metabolized even in conditions of unstable hemodynamics. Secondly, lactate is a more profitable anion compared to chloride, since it is included in biochemical reactions and does not have side effects characteristic of hyperchloremia (for example, impaired renal filtration, hyperchloremic acidosis) (Aramendi I., 2016). Third, it improves microcirculation and gas exchange (Thibault Duburcq, 2017). In addition, the decongestant effect of sodium lactate is realized by reducing intracellular osmotic pressure.

Calcium chloride has a moderate antihistamine and diuretic effect (similar in action to the effects of acid-forming diuretics).

It also acts as a source of calcium ions, which are involved in the processes of transmission of a nerve impulse, an inflammatory response, blood coagulation, and reduction of smooth and striated muscles, especially myocardium.

The latter effect is supplemented by potassium chloride, which has a specific effect on the functioning of the conduction system of the heart. Potassium ions have a negative inotropic and batmotropic, as well as moderate diuretic effects. The introduction of drugs containing potassium ions is especially relevant for hypokalemia of various origins (for example, due to repeated vomiting and diarrhea, with prolonged use of diuretics, against the background of decompensated diabetes mellitus).

Pharmacokinetic characteristics

Effect of administration RheoSorbilact starts from the first minutes and reaches a maximum in 20-30 minutes, when lactate and sorbitol are included in the metabolism. When sodium lactate is introduced into the bloodstream, it is metabolized to form sodium bicarbonate, which contributes to an increase in the alkaline buffer in the blood. In this case, only half of the administered drug is considered active, since sodium lactate exists in the form of L- and D-isomers, the first of which is active, and the second is excreted unchanged in the urine.

After 40-60 minutes, moderate diuretic and detoxification effects develop. In the future, there is a gradual decrease in the effect of the active ingredients of the drug.

Indications and method of use

RheoSorbilact It is widely used both in emergency medicine and in outpatient treatment of various diseases. The capillary-stabilizing and rheological properties of the drug are used to treat microcirculatory disorders in case of shock of any genesis (burn, traumatic, toxic, etc.), as well as for various peripheral blood supply disorders - endarteritis, phlebitis and thrombophlebitis (including post-traumatic), Raynaud’s disease and etc.

Especially effective RheoSorbilact in the complex treatment of intestinal obstruction.In the early phases of acute obstruction, in combination with other methods of conservative therapy (decompression, enema), it activates peristalsis of the small and large intestines and significantly improves blood supply to the intestinal wall. In the late phases of intestinal obstruction, when intoxication and dehydration develop due to sequestration of fluid into the third space, RheoSorbilact great for correcting the water-salt balance in the complex of preoperative preparation. In severe cases of intestinal obstruction, it is used in the postoperative period for the prevention of intestinal paresis and early healing of the surgical area (anastomosis, stoma).

Also RheoSorbilact indicated for infectious diseases, which are accompanied by severe intoxication, repeated vomiting and diarrhea, as well as in surgical practice for disorders that cause the syndrome of a systemic inflammatory response (sepsis). The reaction of the body to a specific or non-specific damage to the body by the vital products (toxins) of various bacteria and parasites is characterized by impaired blood viscosity and the tone of the capillary bed.

Due to the ability to improve capillary blood flow, the drug is applicable in the early period for post-traumatic disorders, as well as for the treatment of burn disease. In these diseases, the presence of a large area of ​​the wound surface is a prerequisite for the release of a large number of pain mediators and pro-inflammatory cytokines that adversely affect capillary blood flow throughout the body. Also, swelling quickly develops directly in the affected area, which leads to the development of local tissue acidosis and circulatory disorders due to sludge of red blood cells.

Due to the cholekinetic effect of sorbitol RheoSorbilact finds application in the treatment of diseases of the biliary tract, such as gallbladder dyskinesia, postcholecystectomy syndrome. As part of complex therapy, it improves the outflow of bile, prevents the formation of biliary sludge and improves the digestion of food.

RheoSorbilact It is indicated for use as part of complex conservative therapy for acute pancreatitis. The effects of improving capillary blood flow, reducing local acidosis and reducing edema have an indirect effect on the pathogenesis of the disease.

The drug is widely used in neurological practice, in particular for the treatment of cerebral ischemia and diabetic neuropathy (Zhivolupov S.A., 2013), as well as for cerebral edema and neuritis (Aramendi I., 2016). In these cases, the main importance is attached to the decongestant effect, which allows you to eliminate the compression of various structures of the central and peripheral nervous system. And the improvement of the rheological properties of blood favorably affects foci of transient ischemia in the structures of the brain.

The dose of the drug is selected individually depending on the clinical situation and the severity of the patients condition. The dose range in this case is 6–25 ml / kg body weight. Usually RheoSorbilact administered intravenously in a dose of 200-400 ml (1-2 vials) per day. In severe cases, it is allowed to increase the dose to 1000 ml and partially injected jet to stabilize the condition.

Contraindications

Somatic contraindications for the use of Reosorbilact include alkalosis of any genesis (respiratory, metabolic, etc.), DIC, cerebral hemorrhage, gastrointestinal bleeding with unstable hemostasis, acute thrombophlebitis (due to the risk of thromboembolic complications). It is not recommended to use Reosorbilact for first aid in case of injuries until the bleeding stops completely (due to its ability to reduce blood viscosity, the drug may interfere with thrombosis).Also, contraindications include severe forms of heart failure, acute renal failure (in the absence of hemodialysis).

Application features

RheoSorbilact can be administered exclusively intravenously. If it enters muscle tissue or subcutaneous fat, it can cause necrosis due to the presence of calcium chloride.

RheoSorbilact it is necessary to carefully prescribe to patients with cholelithiasis, since its cholekinetic effect can trigger the migration of calculi from the gallbladder to the lower biliary tract.

With an overdose of Reosorbilact, symptoms characteristic of alkalosis are noted. Since the components of the drug are metabolized in the human body, there is no need for additional correction of the acid-base balance, it is enough to stop its administration.

The sorbitol contained in the composition is metabolized in the liver to fructose, therefore, the drug is contraindicated in patients with a rare disease - fructose intolerance.

Sorbitol refers to rehydrants and metabolic agents, therefore, the use of RheoSorbilact may be accompanied by increased peristalsis and increased gas formation.

The drug is an osmotic diuretic, that is, it has the property of removing fluid from the intercellular space into the vascular bed, sharply increasing the bcc. Therefore, the drug should be used with caution in patients with severe arterial hypertension. Also, when prescribing it to patients with dehydration, it is necessary to take into account the diuretic effect and be sure to combine RheoSorbilact with other infusion or oral rehydration solutions.

The drug is not contraindicated in pregnant women, during breastfeeding and in children. However, when prescribing to pregnant women, the potential tonic effect on the myometrium should be considered due to the calcium chloride contained in Reosorbilact. As for infusion therapy in children, it is necessary to dose the drug with an infusomat under strict control of the acid-base state of the blood.

The reactions of individual intolerance are not excluded.

RheoSorbilact should never be mixed with carbonate and phosphate-containing solutions because of the possibility of mutual neutralization or the formation of insoluble salts. The drug can not be used as a solvent for other drugs.

Conclusion

In this way, RheoSorbilact finds wide application in modern medical practice. It is suitable for both scheduled use in combination with other drugs, and for the correction of emergency conditions at the prehospital and hospital stage. A wide range of effects allows it to be included in the plan of conservative therapy, preoperative preparation and therapy in the early postoperative period for the prevention of complications (acidosis, intestinal paresis, edema, etc.)