Overview
DESCRIPTION LMD (dextran 40) is a sterile, nonpyrogenic preparation of low molecular weight dextran (average mol. wt. 40,000) in 5% Dextrose Injection or 0.9% Sodium Chloride Injection. It is administered by intravenous infusion. Also described as low viscous or low viscosity dextran, dextran 40 is prepared by acid hydrolysis and differential fractionation of a crude macromolecular polysaccharide...
Mechanism of Action
CLINICAL PHARMACOLOGY The fundamental action of LMD (dextran 40) is the enhancement of blood flow , particularly in the microcirculation. This enhancement is due to: 1. Its primary effect of volume expansion with resultant hemodilution; 2. Maintenance of the electronegativity of red blood cells; 3. Coating of red blood cells and platelets; 4. Increase in the suspension stability of blood; 5. Decrease in the viscosity of blood. It should be emphasized that the above effects are not exerted separately, but conjointly they result in the enhancement of blood flow. LMD, used in the treatment of shock, produces significant increases in blood volume, central venous pressure, cardiac output, stroke volume, blood pressure and urinary output.
Indications
- INDICATIONS AND USAGE LMD (dextran 40) is indicated for use in the adjunctive treatment of shock or impending shock due to hemorrhage, burns, surgery or other trauma. It is not indicated as a replacement for whole blood or blood components if they are available. It should not replace other forms of therapy known to be of value in the treatment of shock. LMD is also indicated for use as a priming fluid, either as a sole prime or as an additive, in pump oxygenators during extracorporeal circulation.
Common Doses
- 20 mL
- 10 mL
- 2 g
- 000 mL
Dosage
DOSAGE AND ADMINISTRATION LMD (dextran 40) is administered by I.V. infusion only. Dextran 1 should be administered prior to administration of clinical dextran solutions. 1. In shock, it is suggested that total dosage not exceed 20 mL/kg for adults and adolescents, during the first 24 hours. The first 10 mL/kg may be infused as rapidly as necessary to effect improvement. It is strongly recommended that central venous pressure be monitored frequently during the initial infusion of the drug.
Contraindications
- CONTRAINDICATIONS LMD (dextran 40) is contraindicated in patients with known hypersensitivity to dextran, in those with marked hemostatic defects of all types (thrombocytopenia, hypofibrinogenemia, etc.) including those caused by drugs (heparin, warfarin, etc.), marked cardiac decompensation and in renal disease with severe oliguria or anuria.
Side Effects
- ADVERSE REACTIONS Antigenicity of dextrans is directly related to their degree of branching. Since LMD (dextran 40) has a low degree of branching, it is relatively free of antigenic effect. However, a few individuals have experienced mild urticarial reactions. More severe reactions, consisting of severe anaphylactoid reaction, generalized urticaria, tightness of the chest, wheezing, hypotension, nausea and vomiting may occur in rare instances.
Interactions
- No major interactions listed on the FDA label. Always consult a healthcare professional.