Dextrans intravenous infusions

Iron dextran is a stable complex of ferric oxyhydroxide and dextran polymers containing 50 mg of elemental iron per milliliter of solution. It can be given by deep intramuscular injection or by intravenous infusion, although the intravenous route is used most commonly. Intravenous administration eliminates the local pain and tissue staining that often occur... 

Most adults with iron deficiency anemia require 1-2 g of replacement iron, or 20-40 mL of iron dextran. Most physicians prefer to give the entire dose in a single intravenous infusion in several hundred milliliters of normal saline over 1-2 hours. Intravenous administration eliminates the local pain and tissue staining that often occur with the intramuscular route and allows delivery of the entire dose of iron necessary to correct the iron deficiency at one time. There is no clear evidence that any of the adverse effects, including anaphylaxis, are more likely to occur with intravenous than with intramuscular administration. 

A single intravenous infusion of 1000 mg iron dextran has also been evaluated in two open label studies, in which idiopathic RLS patients (n = 11) in the one study, and RLS patients with chronic kidney failure (n = 25) in the other study, were included [88, 89], In both investigations, a therapeutic effectiveness was reported for a period of 2 1 weeks, and in one study the authors also noticed a reduction in PLM [88], The results from oral iron therapy seem to be less convincing. In the only double-blind study available in literature, 24 RLS patients were treated for 2 weeks with a daily amount of 325 mg of iron sulfate. Despite the fact that a considerable number of the subjects did not complete the study due to the appearance of side effects, no significant difference in symptom relief was reported between treated and control group. Reduced effectiveness of oral iron therapy could depend... 

Adult respiratory distress syndrome occurred after the intravenous infusion of dextran 40 in a 30-year-old woman, a smoker with a history of insulin-dependent diabetes mellitus, who had sustained an acute inferior myocardial infarction the dextran was given in... 

Of 207 patients with ischemic stroke, stages III or IV, treated with an intravenous infusion of dextran 40 over 4 days, 9 (4.3%) developed acute renal insufficiency attributable to the dextran. Oliguria occurred after a mean time of 4 (range 3-6) days. The incidence of dextran-induced renal insufficiency was higher in patients with pre-existing impaired kidney function. The high risk of death in the patients who developed renal insufficiency was due to non-renal complications, notably pneumonia and pulmonary embolism (10). 

Taylor MA, DiBiasi SL, Bender RM, Santoian EC, Cha SD, Dennis CA. Adult respiratory distress syndrome complicating intravenous infusion of low-molecular weight dextran. Cathet Cardiovasc Diagn 1994 32(3) 249-53. 

Symmetric allergic purpura following the intravenous infusion of iron dextran has exceptionally been noted. In children, transient hepatosplenomegaly has been described as a common finding. 

Hie stability of amoxicillin sodium salt in various intravenous infusion fluids has been studied [33-35], Degradation was faster at the higher amoxicillin concentrations [33] and particularly in fluids containing dextrose, dextran or sorbitol [33-35], Other studies also showed a deleterious effect of carbohydrates and alcohols on the stability of amoxicillin in solution [36,37],... 

Iron-deficiency anemia in chronic PN patients may be due to underlying clinical conditions and the lack of iron supplementation in PN. Parenteral iron therapy becomes necessary in iron-deficient patients who cannot absorb or tolerate oral iron. Parenteral iron should be used with caution owing to infusion-related adverse effects. A test dose of 25 mg of iron dextran should be administered first, and the patient should be monitored for adverse effects for at least 60 minutes. Intravenous iron dextran then may be added to lipid-free PN at a daily dose of 100 mg until the total iron dose is given. Iron dextran is not compatible with intravenous lipid emulsions at therapeutic doses and can cause oiling out of the emulsion. Other parenteral iron formulations (e.g., iron sucrose and ferric gluconate) have not been evaluated for compounding in PN and should not be added to PN formulations. 

They are most commonly used plasma expanders. It is polysaccharide isolated from beet sugar which is formed by the action of Leuconstec mesenteroides. It is available in mainly two forms depending upon the molecular weight. Dextran 70 (mol. wt. 70,000) available in 6% solution and Dextran 40 (mol. wt. 40,000) available in 10% solution. They are infused intravenously in the treatment of shock. Dextran 40 acts more rapidly than dextran 70. It decreases the blood viscosity and prevents the sludging of RBC s. Dextran 70 remains in circulation for longer period (upto 24 hrs) and is slowly excreted by glomerular filtration. 

Local reactions to intravenous iron dextran include transient pain (in some 4% of cases) and phlebitis. The risk of the latter may be reduced by using saline instead of 5% dextrose as diluent. Nevertheless, deep vein thrombosis has been observed in a few patients infused with a dilution of iron dextran in normal saline (SED-8, 514). 

Large doses of intravenous iron dextran and iron saccha-rate have been compared in a retrospective study of 379 patients who had attended peritoneal dialysis clinics in the past 5 years (12). Of these, 62 were selected to receive intravenous iron based on ferrokinetic markers of iron deficiency, non-adherence to oral iron, ineffectiveness of oral iron, or increased erythropoietin requirements. Intravenous iron was given as two injections of 500 mg each 1 week apart in 61 patients, 33 of whom received iron dextran, 23 iron saccharate, and five both iron dextran and iron saccha-rate. One patient developed anaphylaxis to a test dose of iron dextran and was excluded from further therapy. Blood samples were collected before and 3 and 6 months after iron infusions. Five of the 34 patients who received iron dextran developed minor adverse effects and one had an anaphylactic reaction to the test dose. Of the 23 patients who received iron saccharate, one had an anaphylactic reaction and two had transient chest pain, which subsided without therapy. There were more adverse effects with iron dextran (7.4% of injections) compared with iron saccharate (4.3% of injections), but this difference was not statistically significant. The number of episodes of peritonitis also increased during the 6 months after intravenous iron infusion, especially with iron dextran, compared with the number of episodes during the 6 months before iron infusions, although the difference was not statistically significant. 

Two-photon microscopy can be utilized to quantify microvascular flow rates within the kidney. Infusion of a nonfilterable intravenous fluorescent dye results in intravascular cells appearing as dark objects. Endothelial cell dysfunction within the microvasculature can be observed and quantified using the infusion of variously sized, differently colored dextrans or proteins. Movement of these molecules out of the microvasculature and accumulation within the interstitial compartment are readily observed during injury or disease. 

When hemodialysis patients are started on erythropoietin, oral iron therapy alone generally is insufficient to guarantee an optimal Hb response. It therefore is recommended that sufficient parenteral iron be given to maintain a plasma ferritin level between 100 and 800 jlg/L and a transferrin saturation of 20—50%. One approach is to administer an initial intravenous dose of 200—500 mg, followed by weekly or every-other-week injections of25—100 mg of iron dextran to replace ongoing blood loss. With repeated doses of iron dextran—especially multiple, total-dose infusions such as those sometimes used in the treatment of chronic GI blood loss—accumulations of slowly metabolized iron dextran stores in reticuloendothelial cells can be impressive. The plasma ferritin level also can rise to levels associated with iron overload. While disease-related hemochromatosis has been associated with an increased risk of infections and cardiovascular disease, this has not been shown to be true in hemodialysis patients treated with iron dextran. It seems prudent, however, to withhold the drug if the plasma ferritin exceeds 800 jlg/L. 

Jeanes A, Haynes WC, Wilham CA et al. (1954) Characterization and classification of dextrans from ninety-six strains of bacteria. J Am Chem Soc 76 5041-5052 Jellinek EH (1976) Dangers of intravenous fat infusions. Lancet 2 967... 

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