Adult respiratory distress syndrome complicating intravenous infusion of low‐molecular weight dextran

Abstract

Respiratory failure is one of the most uncommon and serious adverse drug reactions. Low-molecular-weight-dextran (Dextran-40) is a useful adjunctive anti-platelet agent in the setting of coronary angioplasty and intracoronary stent placement. We report the occurrence of the adult respiratory distress syndrome following intravenous infusion of Dextran-40.

Safety and Efficacy of Low Molecular Weight Dextran (Dextran 40) in Head and Neck Free Flap Reconstruction

“…13,14 Scholz and Evans 15 have also shown, in a model using dextran with or without hypertonic saline when used for microanastomosis, had a good response in terms of blood flow and prevention of thrombus formation. Albeit its antithrombotic effect, it is also known to cause other major complications involving the Anaphylactoid reactions 0 (0%) 0 (0%) lungs, like noncardiogenic pulmonary edema leading to ARDS, 5,[16][17][18] nephrotoxicity, 19,20 and severe anaphylactic reaction resulting in cardiac arrest. [21][22][23] Several articles have been published comparing dextran 40 with heparin and aspirin.…”

Acute Vertigo Following Cervical Manipulation

“…Low‐molecular‐weight dextran (dextran 40) is a kind of colloid solution, often used as plasma expander in fluid resuscitation, leading to decreased blood viscosity and increased microcirculation. It is frequently used to improve regional perfusion following surgery 15 and to help establish collateral circulation, although the potentially serious complication of noncardiogenic pulmonary edema with dextran 40 has been reported. 16 …”

Is Dextran Infusion as an Antithrombotic Agent Necessary in Microvascular Reconstruction of the Upper Aerodigestive Tract?

“…7 It became a major component of standard treatment after free flap transfer and replantation surgery. [8][9][10][11][12][13] The use of dextran has several possible complications, such as anaphylactoid reactions, 14 idiopathic pulmonary edema, 15,16 hemorrhage, and renal damage. 17 The purpose of this study was to elucidate the necessity of dextran infusion as an antithrombotic agent in microvascular reconstruction after eradication of malignant tumors of the upper aerodigestive tract.…”

“…However, unpredictable complications of dextraninduced anaphylactoid reaction, adult respiratory distress syndrome, cardiac overload, and dextran-associated renal damage have been reported in several studies. 6,[14][15][16][17] Once those complications occur, postoperative care can become very complicated. Mechanical ventilation in an intensive care unit may be required for days or weeks.…”

“…Dextraninduced adult respiratory distress syndrome was another major cause leading to accidental prolonged ventilator dependence. Hein et al 15 and Taylor et al 16 both reported cases of non-cardiogenic pulmonary edema after intravenous infusion of dextran. The exact mechanism of adult respiratory distress syndrome induced by dextran is not well understood.…”