1. Plasma Volume
Expanders’
AKM Akhtaruzzaman

2. Why and What
 To meet daily maintenance need
 To replace ongoing losses
 To correct electrolyte disturbance
 Know the cardiovascular and renal status
 Type of body fluid that has to be replaced

3. Relevant Information
 Body fluid distribution :
Rule of third
 Electrolyte concentration :
Na+ higher in ECF (140 mmol/L)
K+ mostly in ICF (150 mmol/L)

4. Body Fluid- Rule of Third
2/3 rd TBW
42 L(70 Kg)
2/3 rd 1/3 rd
ECF ICF
28 L 14 L
ISS IVS
10.5 L 3.5 L

5. Fluids Available
Conventional crystalloid
 Combination of water and electrolytes
 Low molecular wt.
 Maintain intravascular vol. (Sufficient quantity)
 Half life 20-30 minutes
Balanced solution ( LR, D5¼NS, NS)
Hypotonic (D5W)
Hypertonic (D5NS, D5½NS, D5LR)

6. Composition of common crystalloid fluids
Sol Tonicity Na Cl K Ca Gl Lac
D5W 253
NS 308 154 154 50
D5¼NS 330 38.5 50
D5NS 561 154 154 50
D5½NS 407 77 77 50
LR 273 130 109 4 3 28
D5LR 525 130 109 4 3 50 28

7. Hypertonic Solution
 Sodium concentration is higher than NS
 Saline (1.8%, 3%, 5%, 7.5%, 10%)
 Dextran 60, Dextran 70
 Hydroxyethyl starch
Action
Mobilization of endogenous fluid
Effect on endothelium and cell vol. changes
Release of mediators

8. Colloids
Use
Resuscitation of
severe IVF deficit prior to arrange blood
severe albumin deficit/loss (Burn)
conjunction with crystalloid (3-4L)
Adverse effects
Allergic reaction
Transmit diseases
Interfere Blood Grouping and Coagulation

9. Colloids
 High molecular wt.
 Maintain plasma oncotic pressure
 Restore intravascular vol.
 Half life 3-6 hours
 Common colloids (isotonic solution)
Blood derived colloid
Albumin 5% and 20%, PPF 5%
Synthetic
Starches (Hydroxy ethyl starch) HES
Dextran
Polygelin (Urea Linked gelatin) Haemaccel

10. Ideal Volume expander
1. No effect on extra cellular fluid volume.
2. No effect on Renal function.
3. No effect on coagulation and fibrinolysis
4. No effect on blood grouping, cross matching
and
5. blood sedimentation rate.

11. Ideal plasma Volume expander

12. Properties of ULG
1. ULG is sterile, pyrogen free and does not
contain any preservative
2. ULG is not immunogenic and thus cannot
induce antibody formation
3. Excretion is completed 48 hours after
the end of infusion

13. Urea linked Gelatin (ULG)
 ULG is not stored in the RES or in the organs
 Disturbances of organ function have not been
observed even at higher dosages
 ULG does not impair coagulation & does not
interfere with blood typing, even in the case
of rapid tests
 ULG is eliminated unchanged via kidney &
intestine. 50% of the
 ULG administered is excreted with in 4-8
hours according to the volume requirer

14. Advantages of polygeline (Urea
Linked Gelatin) solution
• Iso-oncotic
• Rehydration of the interstitial space
• Improvement of renal function
• No anaphylactic reactions
• No impairment of blood-grouping

15. Comparison with Electrolyte Solution
Gelatin Electrolyte Solution
pH 7.0–7.6 5.5–6.5
Oncotic pressure Iso-oncotic Non-oncotic
Intravascular/interstitial fluid Restored/maintained Tissue edema
balance
Unlikely Unlikely
Cardiovascular overload
4–6 hours Very short
Plasma half-life (minutes rather than hours)
Renal function maintained/ Not impaired but risk of edema
Effect on renal function improved
Effect on blood coagulation/ Dilution only Dilution only
haemostasis
Effect on subsequent blood None None
typing and cross-matching
Adverse reactions/ side Local cutaneous reactions, Pulmonary edema
effects Transient hypotension,
Histamine release
None None
Transmissions of diseases
5 years. 3 years
Shelf-life If stored at above +25°C: 3 years
2–25° C 2–25° C
Storage

16. Comparison with Whole Blood
Gelatin Whole Blood
pH 7.0–7.6 7.3 – 7.4
Oncotic pressure Iso-oncotic Iso-oncotic
Intravascular/interstitial fluid Restored/maintained Restored/ maintained
balance
Unlikely possible
Cardiovascular overload
4–6 hours Varies according to fraction
Plasma half-life
Renal function maintained/ Usually not impaired
Effect on renal function improved
Effect on blood coagulation/ Dilution only Possible (factor activation)
haemostasis
Effect on subsequent blood None Usually none
typing and cross-matching
Adverse reactions/ side Local cutaneous reactions, Allergic reactions,
effects Transient hypotension, incompatibility reactions
Histamine release
None Significant risk of viral infection
Transmissions of diseases as
5 years. hepatitis B, C and AIDS
Shelf-life If stored at above +25°C: 3 years 3 weeks
2–25° C
Storage 4–6° C

17. Comparison with Hydroxyethylstarch
Gelatin HES
pH 7.0–7.6 5.5–7.0
Oncotic pressure Iso-oncotic Hyperoncotic
Intravascular/interstitial fluid Restored/maintained Tissue dehydration
balance
Unlikely risk increased by volume
Cardiovascular overload expanding effects
4–6 hours 12 hours–17 days
Plasma half-life
Renal function maintained/ Use with caution in renal
Effect on renal function improved impairment
Effect on blood coagulation/ Dilution only May alter coagulation mechanism and
haemostasis prolong clotting time. Dilution effects
Effect on subsequent blood None High dilutions may lead to the
typing and cross-matching formation of rouleaux
Adverse reactions/ side Local cutaneous reactions, Allergic and sensitivity reactions.
effects Transient hypotension, Mechanism unknown
Histamine release
None None
Transmissions of diseases
5 years. 2–3 years
Shelf-life If stored at above +25°C: 3 years
2–25° C < 25° C (do not freeze)
Storage

18. Indication of Gelatin
1. Blood and plasma loss- Hypo-volaemic
Shock
2. Volume loss during and after Surgery.
3. Pre-operative haemodilution for Autologus
Blood Collection (INH)
4. Carrier solution for low dose insulin

19. Haemaccel
 Haemaccel is a 3.5% iso-oncotic polygeline
solution (ULG)
 Haemaccel is a plasma substitute which is iso-
oncotic with plasma
 Its viscosity & pH similar to blood plasma