This is the need-to-know information about Hextend:Hetastarch
Pearls and fun nuggets
1. Hextend may not be that great of a resuscitation fluid for sepsis 😐 In June 2012 a 6S paper was published in the New England Journal of Medicine raising concerns regarding the use of hydroxyethyl starch in sepsis. Specifically, the authors showed that resuscitation with hydroxyethyl starch (as opposed to Ringer’s acetate) resulted in an increased risk of death or end stage renal failure.
2. It may also be bad for hemorrhagic shock 😥 Hextend is linked to a decrease in hematocrit and disturbances in blood clotting. One liter of 6% solution (Hespan) reduces factor VIII level by 50% and will prolong the aPTT and will also decrease vWF.  A coagulation effect of hetastarch administration is direct movement into fibrin clots and a dilutional effect on serum.
3. Where does your body put all that Hextend? 😳 Approximately one-third to two-thirds of administered HES cannot be accounted for by 24-h urinary excretion. In one study the cumulative excretion over 72 h was 50% of the administered dose. HES has remained detectable in plasma 4 months after infusion, and in skin tissue up to 54 months after HES infusion. Administered HES accumulates in large quantities within diverse tissues where it can persist for periods of several years. Therefore, HES should not be administered for longer than 24 hours.