title: Hydroxyethyl starch: a review of pharmacokinetics, pharmacodynamics, current products, and potential clinical risks, benefits, and use.
abstract: OBJECTIVE
  To review and summarize the pharmacokinetics and pharmacodynamics of hydroxyethyl starch (HES), as well as reported risks and benefits of HES infusion, and to provide administration and monitoring recommendations for HES use in dogs and cats.
  
  
  METHODS
  Veterinary and human peer-reviewed medical literature, including scientific reviews, clinical and laboratory research articles, and authors' clinical experience.
  
  
  CONCLUSIONS
  HES solutions are the most frequently used synthetic colloid plasma volume expanders in human and veterinary medicine. The majority of research in human medicine has focused on the adverse effects of HES infusion, with emphasis on acute kidney injury and coagulation derangements. The studies often differ in or fail to report factors, such as the type, amount, interval, and concentration of HES administered; the patient population studied; or concurrent fluids administered. Currently, there is no definitive clinical evidence that the reported adverse effects of HES use in human medicine occur in veterinary species. There is little information available on HES administration techniques or simultaneous administration of additional fluids in human and veterinary medicine. The rationale for HES use in small animals has been largely extrapolated from human medical studies and guidelines. A controlled approach to intravenous fluid resuscitation using crystalloid and HES volumes titrated to reach desired resuscitation end point parameters is outlined for small animal practitioners.
  
  
  CONCLUSIONS
  The extrapolation of data from human studies directly to small animals should be done with the knowledge that there may be species variations and different pharmacokinetics with different HES solutions. Veterinary reports indicate that bolus and continuous rate infusions of 6% hetastarch solutions at moderate doses are well tolerated in feline and canine subjects. Further research in domesticated species is necessary to better define and expand the knowledge regarding use of HES solutions in small animal medicine.
authors.affiliation: Emergency & Critical Care Department, Lakeshore Veterinary Specialists, 2100 W. Silver Spring Drive, Glendale, WI 53209.
authors.forename: Polly A
authors.initials: PA
authors.lastname: Glover
authors.forename: Elke
authors.initials: E
authors.lastname: Rudloff
authors.forename: Rebecca
authors.initials: R
authors.lastname: Kirby
mesh_terms: D000818:Animals; D002371:Cat Diseases / Q000188:drug therapy*; D002415:Cats; D004283:Dog Diseases / Q000188:drug therapy*; D004285:Dogs; D005440:Fluid Therapy / Q000379:methods / Q000662:veterinary; D006895:Hydroxyethyl Starch Derivatives / Q000009:adverse effects / Q000493:pharmacokinetics / Q000494:pharmacology*; D010952:Plasma Substitutes / Q000009:adverse effects / Q000493:pharmacokinetics / Q000494:pharmacology*; D012769:Shock / Q000188:drug therapy / Q000662:veterinary*
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes
keywords: canine and feline; hetastarch; plasma substitutes