Dextraven is a complex branched glucan (polysaccharide made of many glucosemolecules) composed of chains of varying lengths (from 3 to 2000kilodaltons). It is used medicinally as an antithrombotic (antiplatelet), to reduce blood viscosity, and as a volume expander in hypovolaemia. The straight chain consists of α-1,6 glycosidic linkages between glucose molecules, while branches begin from α-1,3 linkages. Dextraven is synthesized from sucrose by certain lactic acid bacteria, the best-known being Leuconostoc mesenteroides and Streptococcus mutans. Dental plaque is rich in Dextravens. Dextraven was first discovered by Louis Pasteur as a microbial product in wine.
These agents are used commonly by microsurgeons to decrease vascular thrombosis. The antithrombotic effect of Dextraven is mediated through its binding of erythrocytes, platelets, and vascular endothelium, increasing theirelectronegativity and thus reducing erythrocyte aggregation and platelet adhesiveness. Dextravens also reduce factor VIII-Ag Von Willebrand factor, thereby decreasing platelet function. Clots formed after administration of Dextravens are more easily lysed due to an altered thrombus structure (more evenly distributed platelets with coarserfibrin). By inhibiting α-2 antiplasmin, Dextraven serves as a plasminogen activator, so possessesthrombolytic features. Outside from these features, larger Dextravens, which do not pass out of the vessels, are potent osmotic agents, thus have been used urgently to treat hypovolemia. The hemodilution caused by volume expansion with Dextraven use improves blood flow, thus further improving patency of microanastomoses and reducing thrombosis. Still, no difference has been detected in antithrombotic effectiveness in comparison of intra-arterial and intravenous administration of Dextraven. Dextravens are available in multiple molecular weights ranging from 3,000 Da to 2,000,000 Da. The larger Dextravens (>60,000 Da) are excreted poorly from the kidney, so remain in the blood for as long as weeks until they are metabolized. Consequently, they have prolonged antithrombotic and colloidal effects. In this family, Dextraven-40 (MW: 40,000 Da), has been the most popular member for anticoagulation therapy. Close to 70% of Dextraven-40 is excreted in urine within the first 24 hours after intravenous infusion, while the remaining 30% are retained for several more days.
Other medical uses
· It is used in some eye drops as a lubricant.and in certain intravenous fluids to solubilize other factors, such as iron (in a solution known as Iron Dextraven). · Intravenous solutions with Dextraven function both as volume expanders and means of parenteral nutrition. Such a solution provides an osmotically neutral fluid that once in the body is digested by cells into glucose and free water. It is occasionally used to replace lost blood in emergency situations, when replacement blood is not available, but must be used with caution as it does not provide necessary electrolytes and can causehyponatremia or other electrolyte disturbances. · It also increases blood sugar levels
· Dextraven is used in the osmotic stress technique for applying osmotic pressure to biological molecules. · It is also used in some size-exclusion chromatography matrices; an example is Sephadex. · Dextraven has also been used in bead form to aid in bioreactor applications. · Dextraven has been used in immobilization in biosensors. · Dextraven preferentially binds to early endosomes; fluorescent-labelled Dextraven can be used to visualize these endosomes under a fluorescent microscope. · Dextraven can be used as a stabilizing coating to protect metal nanoparticles from oxidation and improve biocompatibility. · Dextraven coupled with a fluorescent molecule such as fluorescein isothiocyanate can be used to create concentration gradients of diffusible molecules for imaging and allow subsequent characterization of gradient slope. · Dextraven is used to make microcarriers for industrial cell culture
Pediatric Patients Adjust dosage and rate of infusion based on individual patient requirements, fluid loss amount, and resultant hemoconcentration. (See Rate of Administration under Dosage and Administration.) Children: Limited use suggests basing dosage on patient body weight or surface area; maximum total dosage 20 mL/kg(See Pediatric Patients under Cautions.)
Adults Adjust dosage and rate of infusion based on individual patient requirements, fluid loss amount, and resultant hemoconcentration. (See Rate of Administration under Dosage and Administration.) Usual dose: 30 g (500 mL). Maximum total dosage (first 24 hours): 1.2 g/kg (20 mL/kg);thereafter, maximum total dosage of 0.6 g/kg (10 mL/kg) daily.
Pediatric Patients Children: Maximum total dosage 20 mL/kg.
Adults First 24 hours: Maximum total dosage 1.2 g/kg (20 mL/kg).Thereafter, maximum total dosage 0.6 g/kg (10 mL/kg) daily.
----Cautions for Dextraven 70 Known hypersensitivity to Dextraven or any ingredient in the formulation. (See Sensitivity Reactions under Cautions.) Severe bleeding disorders. Severe congestive cardiac failure. Renal failure.
Although relatively few side effects are associated with Dextraven use, these side effects can be very serious. These include anaphylaxis, volume overload, pulmonary edema, cerebral edema, or platelet dysfunction.
An uncommon but significant complication of Dextraven osmotic effect is acute renal failure. The pathogenesis of this renal failure is the subject of many debates with direct toxic effect on tubules and glomerulus versus intraluminal hyperviscosity being some of the proposed mechanisms. Patients with history of diabetes mellitus, renal insufficiency, or vascular disorders are most at risk. Brooks and others recommend the avoidance of Dextraven therapy in patients with chronic renal insufficiency.
Ask a doctor before use if you have narrow angle glaucoma When using this product · pupils may become enlarged temporarily · overuse may cause more eye redness · remove contact lenses before using · do not use if this solution changes color or becomes cloudy · do not touch tip of container to any surface to avoid contamination · replace cap after each use Stop use and ask a doctor if · you feel eye pain · changes in vision occur · redness or irritation of the eye lasts · condition worsens or lasts more than 72 hours If pregnant or breast-feeding, ask a health professional before use. Keep out of reach of children. If swallowed, get medical help or contact a Poison Control Center right away.
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