Hydroxyethyl Starch and Dextran

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Generally, the major adverse effects associated with colloids are fluid overload, dilutional coagulopathy, and anaphy-lactoid/anaphylactic reactions.24,32 Although derived from pooled human plasma, there is no risk of disease transmission from commercially available albumin or PPF products since they are heated and sterilized by ultrafiltration prior to distribution.24 Because of direct effects on the coagulation system with the hydroxyethyl starch and dextran products, they should be used cautiously in hemorrhagic shock patients. This is another reason why crystalloids maybe preferred in hemorrhagic shock. Furthermore, hetastarch can result in an increase in amylase not associated with pancreatitis. As such, the adverse-effect profiles of the various fluid types should also be considered when selecting a resuscitation fluid. 

The risks associated with blood transfusions and the shortage of available blood have led to increased administration of substitute solutions for volume expansion. Colloids are commonly used and three of the main colloids commonly administered, gelatin, hydroxyethyl starch, and dextran will be discussed. Each one may cause adverse reactions ranging from grade I with skin manifestations to grade IV involving cardiac and/ or respiratory arrest. 

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