Adverse Effects
Anaphylactoid reactions: hypersensitivity, mild influenza-like symptoms, bradycardia, tachycardia, bronchospasm and non-cardiogenic pulmonary edema. Decrease in hematocrit and disturbances in coagulation. One liter of 6% solution (Hespan) reduces factor VIII level by 50% and will prolong aPTT.
HES derivatives have been demonstrated to have increased rates of acute renal failure and need for renal replacement therapy and to decrease long-term survival when used alone in cases of severe sepsis compared with Ringer lactate solution (Brunkhorst 2008). This study specifically used 10% HES with 0.45-0.55 substitution grade and molecular weight of 200 kDa (Hemohes). It also used a regimen without any crystalloids and was criticized for its study design. The effects were tested recently on HES 130kDa/0.4 in patient with severe sepsis, and showed increased rates of renal failure and increased mortality when compared to LR (see NEJM "Hydroxyethyl Starch 130/0.42 versus Ringer's Acetate in Severe Sepsis" By Perner et Al.) It has been recommended that, since medium-MW HES solutions may be associated with harm, these solutions should not be used routinely for patients with septic shock.
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