Is the use of colloids for fluid replacement harmless in children?
OBJECTIVE
Albumin has been regarded as the gold standard for maintaining adequate colloid osmotic pressure in children, but increased cost, the lack of clear-cut benefits for survival, and fear of transmission of unknown viruses have contributed to its replacement by hydroxyethyl starch and gelatin preparations. Each of the synthetic colloids has unique physicochemical characteristics that determine their likely efficacy and adverse effect profile. This review will examine the advantages and disadvantages of the use of different colloid solutions in children with a particular focus on their safety profile.


RESULTS
Dextrans are rarely used because of their negative effects on coagulation and potential for anaphylactic reactions. Gelatin and albumin have little effect on hemostasis, but the disadvantages of gelatin include its high anaphylactoid potential and limited beneficial volume effect. Tetrastarches have significantly fewer adverse effects on coagulation and renal function than the older hydroxyethyl starches and are now approved for children. Dissolving tetrastarches in a plasma-adapted, balanced solution rather than in saline further improves safety with regard to coagulation and acid-base balance.


CONCLUSIONS
Tetrastarches offer the best currently available compromise between cost-effectiveness and safety profile in children with preexisting normal renal function and coagulation.
Saudan
Sonja
S
Pediatric Anesthesia Unit, Geneva Children's Hospital, University of Geneva Hospitals, Geneva, Switzerland. sonja.saudan@hcuge.ch
D000136:Acid-Base Equilibrium / Q000187:drug effects; D000138:Acidosis / Q000139:chemically induced; D000418:Albumins / Q000008:administration & dosage / Q000009:adverse effects; D001777:Blood Coagulation; D002648:Child; D003102:Colloids / Q000008:administration & dosage* / Q000009:adverse effects; D003911:Dextrans / Q000008:administration & dosage / Q000009:adverse effects; D005440:Fluid Therapy / Q000379:methods*; D005780:Gelatin / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage / Q000009:adverse effects; D006937:Hypercholesterolemia / Q000139:chemically induced; D006967:Hypersensitivity / Q000209:etiology; D007668:Kidney / Q000187:drug effects; D010952:Plasma Substitutes / Q000008:administration & dosage* / Q000009:adverse effects; D012306:Risk
D000418:Albumins; D003102:Colloids; D003911:Dextrans; D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes; D005780:Gelatin