what is deca durabolin

What is deca durabolin – plasma-colloidal solution based on hydroxyethyl starch (HES) – high molecular compound consisting of polymerized residues of dextrose. HES is the source of native starch (amylopectin), which undergoes cleavage to produce molecules with a certain mole. weight and Hydroxyethylation in which the free hydroxyl groups are replaced by residues dextrose hydroxyethyl Liaison Group C2 / C6. HES is subjected to prolonged hydrolysis of serum amylase to form oncotically active oligosaccharides and polysaccharides of various molecular weights.

what is deca durabolin, solution for infusion 6% – HES (pentastarch) with an average molecular weight. 200 tys.Da weight and degree of substitution of about 0.5. Due to the ability to bind and retain water has volemic action – the ability to increase blood volume (CBV) to 85-100% of the injected volume, which steadily maintained for 4-6 hours Providing plazmozameshchath action restores the hemodynamics, improves microcirculation and rheological. properties of the blood (due to lower hematocrit index) decreases the plasma viscosity decreases platelet aggregation and inhibits the aggregation of erythrocytes. HES structure similarity with the structure of glycogen explains the high level of tolerance, and the virtual absence of side effects.

Pharmacokinetics
Following intravenous administration appears poykami (for 24 hours – 70% of the administered dose pentastarch) and bile.

A small amount accumulates in the reticuloendothelial system (without causing toxic effects on the liver, lungs, spleen and lymph nodes), which is cleaved by amylase and subsequently excreted by the kidneys and the bowel.

Indications

Prophylaxis and treatment of hypovolemia (shock due to acute blood loss, including intraoperative, trauma, burns, sepsis).
Prevention of hypotension when administered in general anesthesia during spinal and epidural anesthesia.
Microcirculatory disorders and therapeutic hemodilution, including . Isovolemic.

Contraindications:
Hypersensitivity (including starch), intracranial hypertension, intracranial hemorrhage, decompensated chronic heart failure, acute renal failure (oligo, anuria), cardiogenic pulmonary edema, hyperhydration, hypervolemia, dehydration (if necessary correction of electrolyte metabolism) expressed clotting disorders (in-incl. heavy bleeding diathesis, anticoagulation), hyperchloremia, hypernatremia, hypokalemia, hemodialysis, child.

Be wary – Lactation, pregnancy, compensated chronic heart failure and chronic renal failure, chronic liver disease, von Willebrand disease, hemorrhagic diathesis, gipofibrinogenemia.

Dosing and Administration
Enter intravenous drip or bolus.
The dose and rate of administration are set individually depending on the severity of violations hemodynamic severity of the patient’s condition. The first 10-20 ml should be administered slowly (possibility of anaphylactoid reactions).

When razvivshemsya shock the average daily dose is 0.5-1.5 l, the maximum daily dose of -33 mL / kg. In hemorrhagic shock is administered at a rate of yes. 20 ml / h / kg.
In septic shock and burn infusion rate somewhat less.
The daily dose and the speed is calculated depending on the amount of blood loss, hematocrit and hemoglobin index. In young patients, without the risk of cardiovascular and pulmonary complications of therapy duration is set by the level of hematocrit (must be at least 30%).

The maximum rate of infusion depends on baseline hemodynamics and is 20 ml / kg / h.
In order to hemodilution daily dose – 500 ml for a few days up to a total dose of 5 liters, which may be exceeded in exceptional cases, and distributed for a period of up to 4 weeks .
In the absence of an emergency, the recommended infusion rate – 30 minutes at 500 ml.

Treatment and prevention of hypovolemia and shock: The maximum daily dose of 6% solution – 33 ml / kg, corresponding to 2.5 liters per 75 kg of body weight, or 2 g / kg what is deca durabolina; maximum injection speed – 20 ml / kg / h (1.5 liters / 75 kg / h or 1.2 g / kg / h).

The duration of application is determined by the duration and level of hypovolemia.
Hemodilution: the administration is Isovolemic (with its own blood sampling) or hypervolemic (without sampling his own blood) for small (250 ml), medium (500 ml) and high daily doses (2 x 5t) 0 mL). The criterion of effectiveness is determined for each patient declines in hematocrit. . Infusion Rate: 250 ml for 0.5-2 hours, 500 ml of 6.4 hours, 2 times 500 ml 8-24 hours for duration of administration of 6% solution – 10 days.

Acute normovolemic hemodilution administration for reducing blood during surgery: 6% solution was administered directly prior to surgery in a ratio of 1: 1 at an hematocrit Ziehl after acute normovolemic hemodilution not lower than 30. Blood sampling – 2-3 x 500 mL own blood 2-3 daily dose of 500 ml, speed of blood sampling – 1 liter for 15-30 min, the injection rate – 1 liter for 15-30 minutes. Typically use single administration of the drug immediately before surgery. Repeated use is possible if the source is in the hematocrit of normal limits. In a critical situation possible the rapid introduction of 500 ml (under pressure). With the introduction of the drug under the pressure of the air from the bottle must first be removed (risk of embolism). Speed intraoperative administration, as well as in patients with septic shock, burns and must be reduced.

At therapeutic hemodilution drug is used for multi-day or multi-week infusion regimens.

Many days infusion scheme daily infusion dose – usually 0.5-1 liters of 6% what is deca durabolina solution; when sudden deafness and “intermittent” limp – from 500 to 750 ml / day in the acute phase of ischemic stroke – 750-1000 ml / day; the rate of introduction of -75-250 ml / h, the duration of the course – 5-10 days. In the acute phase of ischemic stroke at the start of therapy may be added to the so-called loading dose of 250-500 ml of component, wherein the rate of introduction is carried out with high speed (for example up to 250-500 ml / h).

When multi-week infusion fluid circuit is carried out 2-3 times a week for 250-500 ml at a rate of 125-250 ml / h, the duration of treatment – usually 3-6 weeks. In many cases it is recommended adaptation administered volume of drug (if necessary -krovopuskanie) to haemodynamic and / or hemorheological parameters (central venous pressure – 15 mm Hg, hematocrit – 38-42 et al.).

Side effects:
Allergic reactions, rare – anaphylactoid reactions, nausea, vomiting, hypotension, tachycardia, fever, headache (you must stop the introduction of the drug). Violations of hemodynamics (with the rapid introduction and use of high doses), persistent reversible itching. Increased serum amylase activity (not associated with clinical symptoms of pancreatitis).

Overdose
With the rapid introduction in large quantities can trigger the development of acute left ventricular failure and pulmonary edema.

In case of complaints of chest tightness, shortness of breath, back pain, as well as in the event of fever, cyanosis, poor circulation and breathing should stop administering the drug and conduct appropriate symptomatic therapy.

Interaction with other drugs
if necessary mixing with other drugs should be observed complete asepsis; you need to ensure compatibility and good mixing drugs.

Specific guidance
In connection with the possibility of allergic reactions, the introduction of the first 10-20 ml of the solution should be carried out slowly (drip), carefully monitoring the patient’s condition.

Treatment should be under the control of the BCC, electrolyte content, white blood cells, platelets, hemoglobin, blood coagulation parameters, renal function.
At the beginning of therapy monitoring of creatinine in serum is necessary. If the limit values of creatinine content (1.2-2 mg / dL or 106-177 mmol / l – compensated renal failure), you must carefully weigh the possibility and the need for treatment and be sure to carry out frequent monitoring of fluid balance.
It should be borne in mind that can influence what is deca durabolin clinico-chemical parameters (glucose, protein, erythrocyte sedimentation rate, fatty acids, cholesterol, sorbitdegidrogenazu, urine specific gravity).
high doses of the drug leads to a decrease of hematocrit, hemoglobin concentration, and plasma protein. Values below 10 g hemoglobin and hematocrit% below 27 are considered to be critical. Since total protein indices less than 5 g / dl of albumin shows the introduction. When blood loss of more than 20-25% of the BCC shown supplementation of packed red blood cells.
In shock conditions, due mainly loss of water and electrolytes (vomiting, diarrhea, burns), after an initial treatment with further treatment should be carried out with the help of a balanced electrolyte solution.

Do not mix the drug with the other drugs in the same container and the same system. During treatment is necessary to ensure adequate fluid flow in the body. In the event of anaphylactoid reactions administration of the drug should be discontinued, the patient must be set to “lying” with raised above the head level of the lower limbs, the breathing passages; then enter epinephrine intravenously, previously diluted with 1 ml (. 1: 1 th) to 10 ml – must first enter slowly 1 ml solution (0.1 mg), while controlling the heart rate and blood pressure; administration of epinephrine can be repeated. Then intravenously administered 5% human albumin solution (for volume replacement), glucocorticosteroid drugs (250-1000 mg prednisolone), antihistamine drugs.
Patients should be under constant medical supervision, additional therapeutic measures to be taken depending on the condition of patients.

In the treatment of patients whose blood type is not installed, it is necessary to bear in mind that the introduction of large volumes what is deca durabolina can complicate interpretation of agglutination results in the determination of blood groups.
After administration amylase activity is markedly increased in the blood, which returns to normal after 3-5 days (may interfere with the laboratory diagnosis of pancreatitis, without affecting the clinical picture).

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