Hydroxyethylstärkebasierte

Hydroxyethyl starch (HES) is a synthetic colloid used as a plasma volume expander in intravenous fluid therapy. It is produced by hydroxyethylating starch, typically derived from amylopectin, resulting in molecules of varying molecular weight and degree of substitution. These properties influence how long the solution remains in the intravascular space and its effects on coagulation.

Variants differ in molecular weight and substitution level. Higher molecular weight and greater substitution tend to prolong circulation time but increase the risk of coagulation disturbance and kidney injury. The clinical choice of product reflects a balance between desired volume expansion and potential safety concerns.

Medical use and administration: HES solutions are used to treat hypovolemia and to maintain circulatory volume during surgery or after blood loss. They are given intravenously, with dosing tailored to the product and clinical situation. Use is generally limited to short durations and carefully considered in patients with kidney impairment, bladder outlet obstruction, or sepsis, due to safety concerns.

Safety and regulatory status: Administration of HES has been associated with coagulation abnormalities and an increased risk of acute kidney injury, particularly in critically ill or septic patients, as well as hypersensitivity reactions. As a result, many regulatory bodies have restricted or withdrawn approval for certain indications and durations, and guidelines increasingly favor crystalloids or albumin depending on the clinical context.