Polyglicin (solution for infusion)
Рolyglucinum
International unlicensed name
Dextran.
Pharmacotherapy group
Rehydrants. Regulators of water-salt balance and ABB. Detoxicant.
Composition
1 l of solution for infusion contains dextran 60 g with molecular mass from 50000 to 70000.
Pharmacological action
Pharmacodynamics
The preparation is 6% glucose polymer colloid solution (dextran) with molecular mass 60000±10000 with addition of 0,9% sodium chloride solution.
It is used as a plasma-substituting antishock preparation of hemodynamic action.
Polyglucin is a hydrophilic polysaccharide that binds water. Each gram sorbs 25 ml water due to what the volume of circulating plasma after administration of the preparation restores quickly. Due to its relatively high molecular mass dextran contained in the preparation slowly penetrates through vascular walls and on administration into the circulatory trace it circulates in it for long. As a result, blood pressure increases and keeps at a high level for long, and tissue edema reduces.
Disaggregating action of dextran on erythrocytes has a positive effect on microcirculation damaged during the shock.
Pharmacokinetics
24 hours after the infusion of the preparation the concentration of dextran reduces app.up to 40% of the amount of the administered preparation. Dextran is mainly excreted by the kidney (about 50% in the first hours after the administration), its small amount gets into the system cells of the monocytic macrophage where it splits into glucose. Small amount is excreted through the gastrointestinal tract.
It does not participate in the carbohydrate metabolism.
Indication
Polyglucin is used as a therapy and prophylactic medicine in case of shock developed as a result if injury, acute hemorrhage, intoxication, sepsis and other reasons; operation shock and burn shock.
Route and dosage
Polyglucin is administered intravenously or intra-arterially. It is recommended to start the transfusion of polyglucin drop-by-drop. After administration of first 10 and further 30 drops it is necessary to make a break for 3 minutes.
The dose of polyglucin and the speed of administration should be determined with regards to the patient’s condition, his blood pressure, heart rate, hematocrit, respiration rate, skin integument color.
Shock developed, polyglucin is administered intravenously by jetting in the dose from 400 till 1200 ml per administration. If necessary, the amount of the preparation can be increased up to 2000 ml. When the blood pressure increases up to the value close to the standard one, it is recommended to switch to drop-by-drop administration. On loss of blood more than 500 ml and marked anemization, the infusion of polyglucin should be accompanied by blood transfusion.
The transfusion of polyglucin does not exclude the necessity to carry out antishock therapy (anesthetization, administration of cardiac, tonic and hormone preparations, etc.).
During chirurgical operations in order to prevent the operation shock development it is recommended the infuse polyglucin drop-by-drop with switching to jet introduction in case of blood pressure drop. In case of a drastic drop of the blood pressure (lower than 60 mm merc.) intra-arterial administration is adequate in the dose up to 400 ml (sometimes even more). In the post operation period jet and drop introduction of polyglucin is an effective means to prevent post operation shock.
The dose in children is 10—15 ml/kg.
On treatment of burn shock the amount of polyglucin and the speed of adminidtration depend on the patient’s general condition. During first 24 hours up to 2000—3000 ml of the preparation can be administered, during further 24 hours — up to 1500 ml; for children: during first 24 hours the amount of the preparation administered is 40—50 ml/kg, and later – 30 ml/kg. On major and deep burns the treatment with polyglucin should be combined with administration of plasma, albumin, gamma-globulin, and on burns more than 30—40% of the body surface – with blood transfusion.
Side effects
On administration of polyglucin allergic reactions are possible (urtical eruption, itching, Quincke’s edema, as well as hearts acceleration, blood pressure fall, temperature rise. In such cases the treatment with polyglucin should be stopped and the appropriate therapy should be carried out.
Contraindications
Polyglucin is contraindicated on cranium injuries proceeding with higher intracranial pressure, high blood pressure and other cases for which introduction of big amounts of liquid is contraindicated.
Polyglucin transfusion is not indicated on prolonged internal hemorrhage (lungs, kidney, etc.), except cases of heavy hemodynamics disturbances (blood pressure drop lower than 60 mm merc.). In such cases the jet infusion of polyglucin provides blood pressure increasing up to the critical level, after what the transfusion of blood or plasma should take place.
Precautions
It is recommended to start the administration drop-by-drop and after first 2—5 ml a break for three minutes is necessary to assess the situation (bioassay on compatibility).
Interaction with other medications
The preparation can be used in combination with other widely used transfusion preparations.
Product form
Solution for infusions in bottles 400 ml.
