Hypotension dextran

Adverse effects of IV iron include allergic reactions, hypotension, dizziness, dyspnea, headaches, lower back pain, arthralgia, syncope, and arthritis. Some of these reactions can be minimized by decreasing the dose or rate of infusion. Sodium ferric gluconate and iron sucrose have better safety records than iron dextran. Iron dextran requires a test dose to reduce the risk of anaphylactic reactions. 

The syndrome of acute hypotension, adult respiratory distress syndrome, non-cardiogenic pulmonary edema, anemia, coagulopathy, and anaphylactic reactions after the administration of dextran 70 is referred to as the dextran syndrome (36-39). Factors other than acute volume overload due to intravascular absorption of dextran are thought to account for the syndrome. A combination of diverse pathophysiological factors may be responsible, namely direct pulmonary toxicity, activation of the coagulation cascade, release of vasoactive mediators, hypotension, pulmonary edema, intravascular intravasation of fluids, dilution of blood, and impaired renal and hepatic clearance. Cases of pulmonary edema are described under the section Respiratory. 

EUingson TL, Aboulafia DM. Dextran syndrome. Acute hypotension, noncardiogenic pulmonary edema, anemia, and coagulopathy following hysteroscopic surgery using 32% dextran 70. Chest 1997 111(2) 513-18. 

Although hetastarch and dextran 70 have been used clinically in horses (Greatorex 1977, McFarlane 1999), it remains to be seen whether either offers any advantage in terms of clinical outcome when compared with crystalloids. Furthermore, some of the theoretical benefits of colloids over crystalloids have not been observed in some experimental models and clinical trials. For example, increased extravascular lung water was foimd in an endotoxic pig model (Baum et al 1990) but not a septic rat model (Rackow et al 1989) when crystalloid and hetastarch resuscitation were compared. In preterm hypotensive human infants, treatment with 5% albumin resulted in significantly greater fluid retention than treatment with isotonic saline and the two treatments were equivalent in other respects (So et al 1997). 

Low- or high-molecular-wed it dextran administration may result in allergic reactions, which are evidenced by urticaria, hypotension, nausea, vomiting, headache, dyspnea, fever, tightness of tlie ch t, and wheezing. Hyiierglycemia and phlebitis may be seen with administration of glucose. 

Other chemical inducers, such as pyran copolymers, tilorone, diethylaminoethyl dextran, and heparin, also have been used. Tilorone is an effective inducer of interferon in mice, but it is relatively ineffective in humans. Initial use of interferon and its inducers instilled intranasally after rhinovirus exposure was successful in the prevention of respiratory diseases. The clinical success of interferon and its inducers has not yet been established, although they may play a significant role in cell-mediated immunity to viral infections and cancer. Disadvantages of interferon use include unacceptable side effects, such as fever, headache, myalgias, leukopenia, nausea, vomiting, diarrhea, hypotension, alopecia, anorexia, and weight loss. 

Other workers have also noted non-reactivity in Wistar rats [12, 216] and West [671, 672] reported its occurrence in both brown and black wild rats. It was suggested that the mutation to non-reactivity in Wistar albino stocks may have arisen by chance crosses with these wild rats however, it is also possible that non-reactivity to egg-white and dextran may have arisen in different colonies through spontaneous mutations. The incidence of non-reactivity in one colony of Wistar albino rats is reported to be on the increase [30] but the significance of this is unknown although natural selection cannot be excluded. In this context, it may be significant that non-reactors are relatively more, resistant than reactors to traumatic and tourniquet shock [206] and also to anaphylaxis, pain and thermal oedema [32, 205, 590]. Moreover, although intravenously injected histamine produces hypotension in both reactor and non-... 

Adverse reactions to dextran 1 were investigated in trials involving over 70,000 patients. The following reactions and incidences were recorded cutaneous reactions 0.016 % moderate hypotension 0.014 % severe hypotension 0.001 % bradycardia and moderate hypotension 0.013 % bradycardia and severe hypotension 0.001 % bradycardia alone 0.004 % and mild symptoms (nausea, pallor, shivering) 0.011 %. 

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