Evaluation of hetastarch.

The indications, pharmacology, adverse reactions, clinical studies, dosage, and cost of hetastarch are reviewed. Hetastarch is a plasma volume expander used in adults for the treatment of shock caused by hemorrhage, burns, surgery, sepsis, or other trauma. It is a heterogenous macromolecular agent derived from starch and is composed primarily of amylopectin. The usual dose of 6% hetastarch is 500-1000 ml; total dosage should not exceed 1500 ml/day (20 ml/kg). The dose of hetastarch should be adjusted for patients with severe renal impairment because its major route of elimination is the urine. Adverse reactions associated with its use are minor defects in coagulation produced with recommended doses and dose-related hematologic abnormalities with infusions greater than 1500 ml. Elevations in serum alpha-amylase and indirect bilirubin levels have also been reported. Hetastarch appears to be comparable with albumin as a plasma volume expander and is substantially cheaper. Few controlled studies with hetastarch have been published, and more data are needed to evaluate its effectiveness compared with other plasma volume expanders.