Dextran in major burns

Dextran is a polymer of glucose. It is available in a variety of molecular weight solutions:

• 40,000 daltons; used more in the United States and thought to be the best at improving vascular dynamics by reducing red cell sludging
• 70,000 daltons; used more in Europe
• 150,000 daltons

One gram of dextran adsorbs at least 13 mls of water, at least twice the volume of an equivalent mass of non-colloid protein. Due to its osmotic properties, it increases urine output; 40% of dextran is excreted in the urine, the rest is metabolized. Hence, the urine output cannot be a reliable index of tissue perfusion in a patient resuscitated with dextran.

Disadvantages of dextrans include more allergic reactions and difficulty with blood grouping, particularly for the higher molecular weight solutions.

Typical infusion rates are 2mls/kg/hour.