NEW CONCEPTS IN FLUID REUSCITATION

Tetraspan® is a 4th generation starch (i.e. Tetrastarch) based colloid in a balanced electrolyte carrier similar to our own blood plasma, there by making it the only “Isotonic Balanced colloid” for easy & effective fluid resuscitation.

Electrolytes Tetraspan® Plasma HES 130 in 0.9% saline
Na+ (mmol/L) 140 142 154
K+ (mmol/L) 4 4.5
Ca2+ (mmol/L) 2.5 2.5
Mg2+ (mmol/L) 1 0.85
Clˉ (mmol/L) 118 103 154
HCO3ˉ (mmol/L) - 24
Lactates (mmol/L)- 1.5
Acetate (mmol/L)24 -
Malate (mmol/L) 5 -
Colloid HES 130/0.42 Albumin HES 130/0.40

Data source- Fluid Management by Prof. Dr. med. R. Zander

Limitations of 0.9% saline carrier:
1. Contains only sodium & chloride electrolytes unlike plasma which also has calcium, potassium, magnesium & bicarbonates.
2. Sodium & chloride concentration are very high compared to plasma and can lead to Hypernatremia & hyperchloremia respectively.
3. Absence of buffer can lead to dilutional acidosis.

Tetraspan the only “Isotonic Balanced colloid” offers the following benefits over saline based colloids:
1. Tetraspan® contains all electrolytes in plasma like concentration unlike saline which contains only sodium & chloride in higher concentration than blood plasma.
2. Tetraspan® Improves coagulation profile of the patients (as calcium is present which plays a vital role in wound closure) resulting in less blood loss.
3. Tetraspan® reduces the unwanted side effects of Cardiopulmonary bypass like inflammation.
4. With Tetraspan® the chances of post operative nausea, vomiting & headache are significantly low since there is no chance of hyperchloremic acidosis & hypernatremia.
5. Tetraspan® is the only colloid which contains Acetate & Malate as metabolizable anions (i.e. as precursor for bicarbonates) there by reducing the chance of dilutional acidosis.
6. In Tetraspan® solvent being Plasma like has no side effect on vital organ functioning like heart, kidney etc evident from clinical references.



References:
1. BJA- Dr. J. Boldt- The balanced concept of fluid resuscitation.
2. TATM- Dr. J. Boldt- Saline versus balanced HES: does it matter?
3. Intensive care Med.- Dr. J. Boldt- Influence of Balanced HES on inflammation, endothelial activation, kidney integrity during cardiac study.
4. Dr. J. Boldt- Impact of balanced and unbalanced HES on blood coagulation.
5. Dr. J. Boldt- In Vitro coagulation study.
6. Dr. J. Boldt- Balanced HES in abdominal surgery.