Sideeffects

Adverse reactions include the infusion of excess volume which may be associated with edema formation (saline solutions, colloid solutions) or water intoxication (5 per cent glucose). Edema formation may occur despite infusion of apparently appropriate volumes. Conversely, the consequences of inadequate treatment include organ dysfunction and death. Thus the acceptance of the minor side-effect of edema may be necessary to ensure adequate resuscitation.

Allergic phenomena are associated with all colloid fluids ( Watkins 1991). These may range from urticaria (the most common effect seen with gelatins) to severe anaphylaxis with cardiovascular collapse (more commonly seen with dextrans). Reactions may be classical IgE mediated or complement mediated and delayed in onset. The incidence of allergic reactions is low with any of the colloid solutions (0.01-0.15 per cent). With longer-acting colloid solutions (e.g. high-molecular-weight hydroxyethyl starch), anaphylactoid reactions may require prolonged support.

Hemostatic defects include dilution coagulopathy associated with any plasma substitute. In addition, dextrans reduce the activities of factors V and VIII, fibrinogen, and prothrombin, decrease platelet adhesion, and prolong bleeding time. These effects are more severe with higher-molecular-weight fractions. Hydroxyethyl starch solutions also reduce factor VIII activity and platelet aggregation (rather than adhesion), again particularly with higher-molecular-weight fractions. These effects are rarely associated with clinical bleeding.

Sleep Apnea

Sleep Apnea

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