Geck

GEK is a perfusion solution and blood substitute. It belongs to the category of hydroxyethyl starch drugs.

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Indications Geca

It is used to eliminate hypovolemia that occurs due to acute blood loss (in situations where the use of crystalloids alone is considered ineffective).

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Release form

Released as an infusion solution in polyethylene or glass bottles, with a volume of 250 or 500 ml. Inside a separate package - 1 or 10 bottles.

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Pharmacodynamics

The medicine GEK is a colloidal plasma substitute. It contains hydroxyethyl starch, which dissolves in an isotonic solution of sodium chloride.

The duration of the effect of the drug, which contributes to the increase in plasma volume, depends to a greater extent on the values of the MS, and to a lesser extent on the MM. After the procedure of hydrolysis of the polymers of the substance of HEC, performed by the intravenous method, small molecules are always formed. They have oncotic activity, and are then excreted through the kidneys.

During the infusion procedure, the hematocrit level and the blood plasma viscosity index decrease.

After the drug is infused into people with hypovolemia, the volume of blood circulating in the body is normalized, and in addition, cardiac function and hemodynamics are improved. Blood volume is maintained at an optimal level for at least 6 hours.

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Pharmacokinetics

After parenteral infusion, the bioavailability of the drug is 100%. The drug's parameters are not those of a standard molecularly homogeneous component, but are more like the characteristics of a mixture of several individual elements that differ in molecular weight and the degree of substitution. Therefore, the currently accepted rules for pharmacokinetic parameters can be applied to GEK only with great limitations, because its properties are constantly changing over time.

For people using the drug, the most important thing in the process of assessing the indicators of the replaced volume of blood circulating inside the body is the time period during which the effects of replenishment of this volume, achieved with the help of the substance HEC, are supported. As a result, when comparing drugs, it is allowed to use indicators of the duration of the presence of plasma substitutes inside the body (this is expressed as the initial half-life - provided that there are no differences in the measurement intervals, as well as in the size of the infusion dosage and its circulation).

The initial half-life of the substance from blood serum depends on the type of infusion and the rate of administration, and is approximately 5-7 hours.

Molecules of the HES element, having a size smaller than the threshold of excretion, are excreted by the kidneys, by filtration of the glomeruli. With a single use of a dosage of 500 ml, about 50% of the administered drug is determined in the urine over a 24-hour period.

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Dosing and administration

GEK can only be used at the initial stage of restoring the optimal volume level - the maximum time period is 24 hours.

The initial 10-20 ml of the drug is administered slowly, carefully monitoring the patient's condition (to prevent the development of anaphylactic reactions).

The drug should be prescribed in the minimum effective dosages and for a short period of time. During therapy, constant monitoring of hemodynamics is required with immediate discontinuation of the drug once the required hemodynamic values are reached. It is prohibited to exceed the specified dosage limits.

No more than 18 ml/kg of the drug can be administered per day (this figure is equivalent to 1.8 g/kg of the HES substance). Taking into account the function of cardiac blood flow, the rate of infusion performed should not exceed 18 ml/kg per 1 hour.

The solution is administered exclusively by intravenous injection.

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Use Geca during pregnancy

There are no studies on the safety of using HEC in pregnant women. This infusion solution is prohibited to be prescribed in the 1st trimester, and during the 2nd and 3rd trimesters it can be used only if there are vital indications (in cases where the doctor believes that the possible benefit to the woman outweighs the likely risk of complications to the fetus).

Since there is no information about the active substance entering breast milk, it is necessary to prescribe GEK to nursing mothers with caution.

Contraindications

Main contraindications:

• the presence of intolerance to the active component or other elements of the drug;
• presence of burns or sepsis;
• people in critical condition;
• RRT or renal failure;
• severe coagulopathy, as well as hypervolemia;
• cerebral or intracranial bleeding;
• congestive heart failure;
• hypokalemia, as well as severe forms of hypernatremia or hyperchloremia;
• severe functional liver disorders;
• patients immediately after organ transplantation;
• pulmonary edema;
• hyperhydria or, conversely, dehydration;
• pediatric patients.

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Side effects Geca

Using the solution may cause the following side effects:

• disorders of the lymph and hematopoietic system: a decrease in hematocrit, as well as plasma protein levels due to the ongoing thinning of the blood. Large doses of the drug can cause thinning of concentrated coagulation factors, as a result of which they can affect blood clotting. Bleeding time may increase. However, no effect on platelet function has been identified, nor has there been any drug-significant bleeding. With rapid administration of the drug (or administration in large quantities), a rapid increase in circulating blood volumes is possible;
• reactions of the digestive system: liver damage is possible;
• manifestations from the subcutaneous layer with the skin: prolonged use of the drug can provoke itching (it can develop after the end of the course of therapy and last for several months, causing quite unpleasant sensations);
• results of laboratory tests and studies: after the infusion procedure, the amylase level in the serum increases significantly, but this cannot be considered a symptom of pancreatic disease. The development of hyperamylasemia is associated with the formation of a complex called "HES-amylase", which is excreted by the kidneys quite slowly;
• urinary and renal dysfunction: lumbar pain has occasionally been observed. If such symptoms occur, the infusion should be stopped and the required amount of fluid should be provided, while carefully monitoring the serum creatinine level. Kidney damage is also possible;
• Immune manifestations: anaphylactic symptoms of varying severity. There is information about the development of anaphylactic manifestations when using GEC - among them a slight increase in temperature, vomiting, itching, a feeling of cold, and urticaria. It is also possible that the salivary glands in the area under the jaw and near the ears will enlarge, and in addition, there may be mild flu-like symptoms (headaches or muscle pain) and swelling in the legs. Severe hypersensitivity reactions also occur, against the background of which a shock condition develops, and life-threatening manifestations appear (respiratory and cardiac arrest), but they are isolated. If symptoms of hypersensitivity appear, it is necessary to immediately stop the infusion and begin to perform generally accepted emergency procedures;
• Signs of anaphylaxis: these symptoms can develop in a few minutes. Among the symptoms that can be alarming signs are sudden reddening of the skin or the development of severe itching. In some cases, the patient feels suffocated, a lump in the throat appears. As the disorder progresses, abdominal cramps, nausea and tachycardia appear, as well as a sharp drop in blood pressure, which can lead to loss of consciousness, as well as respiratory and cardiac arrest.

To eliminate anaphylaxis (if the first symptoms appear - nausea and skin manifestations), it is necessary to stop the infusion procedure, while leaving the cannula inside the vein or providing the necessary access to it in another way. Then the patient should be positioned so that his head is lowered, after which his airways should be freed. In addition, immediate intravenous administration of adrenaline is required (adrenaline solution in the amount of 1 ml should be diluted in 10 ml (proportion 1 to 1000)). First, 1 ml of the prepared solution (0.1 mg of adrenaline) is administered, while monitoring blood pressure and pulse rates. To increase the volume, an intravenous injection of human albumin (5%) is administered. In addition, it is recommended to administer prednisolone or another drug from the GCS group (250-1000 mg) intravenously. Prednisolone can be administered multiple times. For children, the dosage of adrenaline and prednisolone should be reduced based on their weight and age. Other methods are also used, including artificial respiration, oxygen, and antihistamines. The victims should be treated in the intensive care unit.

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Overdose

In case of acute drug intoxication, hypervolemia may develop.

If this disorder develops, the infusion must be stopped immediately, and then, with the doctor's prescription, a diuretic can be used. If an overdose occurs, there is also a possibility of an increased risk of bleeding.

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Interactions with other drugs

In case of mixing with infusion solutions, concentrated means for the preparation of these solutions or injection solutions, as well as with powders or other dry elements for the preparation of injection drugs, it is necessary to check the miscibility and compatibility of these drugs very carefully each time, at least visually. But, in any case, it is impossible to exclude drug or chemical incompatibility of drugs that is not noticeable to the eye.

When combined with aminoglycosides, the drug GEK is capable of potentiating their nephrotoxic properties.

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Storage conditions

The medicine does not require special storage conditions. It is prohibited to reuse a bottle that has already been used. The solution must be kept out of the reach of small children.

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Shelf life

GEK is permitted to be used for a period of 3 years from the date of manufacture of the drug.

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