Pentastarch

Pentastarch is a synthetic derivative of starch, which has five hydroxyethyl groups.

It is sold under the name Pentaspan and used for fluid resuscitation. It is considered a plasma expander because it remains primarily intravascular after infusion.

Choice of resuscitation fluid

The choice of fluid (normal saline vs. Ringer’s lactate vs. pentaspan) is controversial.^[1]

Physiologically, fluid with pentaspan stays primarily in the blood plasma. This is different than normal saline, which shifts quickly into the intracellular compartment.

Advocates of pentaspan use believe that:

the primary deficit in fluid resuscitation is intravascular volume loss^[1] and
use of normal saline may lead to pulmonary edema, particularily in older patients.^[1]

Normal saline versus pentastarch

Casualty

Pentastarch in the emergency setting does not give a survival advantage; however, significantly less volume is required for resuscitation.^[2]

Cardiac surgery

A study is currently being done to compare normal saline with pentastarch following cardiac surgery.^[3]

Cost

Pentastarch is more expensive than normal saline, but less expensive than albumin.

References

↑ ^1.0 ^1.1 ^1.2 Falk JL, Rackow EC, Weil MH (1983). “Colloid and crystalloid fluid resuscitation”. Acute care. 10 (2): 59–94. PMID 6085668.
↑ Younes RN, Yin KC, Amino CJ, Itinoshe M, Rocha e Silva M, Birolini D (1998). “Use of pentastarch solution in the treatment of patients with hemorrhagic hypovolemia: randomized phase II study in the emergency room”. World journal of surgery. 22 (1): 2–5. PMID 9465753.
↑ Double Blind Randomized Trial of Saline vs Pentaspan for Resuscitation After Cardiac Surgery. ClinicalTrials.gov. URL: http://clinicaltrials.gov/show/NCT00337805. Accessed on: July 21, 2007.

External links

Pentaspan monograph – rxmed.com.
Structure of Pentaspan.

Template:WikiDoc Sources

[falk-1] 1.0 ^1.1 ^1.2 Falk JL, Rackow EC, Weil MH (1983). “Colloid and crystalloid fluid resuscitation”. Acute care. 10 (2): 59–94. PMID 6085668.

[2] Younes RN, Yin KC, Amino CJ, Itinoshe M, Rocha e Silva M, Birolini D (1998). “Use of pentastarch solution in the treatment of patients with hemorrhagic hypovolemia: randomized phase II study in the emergency room”. World journal of surgery. 22 (1): 2–5. PMID 9465753.

[3] Double Blind Randomized Trial of Saline vs Pentaspan for Resuscitation After Cardiac Surgery. ClinicalTrials.gov. URL: http://clinicaltrials.gov/show/NCT00337805. Accessed on: July 21, 2007.

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