High incidence of pruritus after large doses of hydroxyethyl starch (HES) infusions

Abstract

Our study indicates that there is a dose-dependency for the incidence of HES-induced pruritus, and that in some cases the pruritus may be severe and long-lasting.

Hydroxyethyl Starches and Pruritus: A Real Problem?

“…15 Therefore, the incidence of pruritus was low (0% and 11%, respectively) and no difference to the control groups (Ringer' s lactate) was observed. This is not a surprise since pruritus following HES administration frequently develops tardily and is generally observed only with higher cumulative doses exceeding 200 g. 10,12,13,[16][17][18][19] However, other studies, which were not prospective and randomized, have assessed a possible link between the administration of HES and the development of pruritus. These studies show a very variable incidence of pruritus, varying between 0-54 %, [8][9][10][11][12][13][16][17][18][19][20] and a link between the total amount of HES infused and the incidence and severity of pruritus.…”

“…This is not a surprise since pruritus following HES administration frequently develops tardily and is generally observed only with higher cumulative doses exceeding 200 g. 10,12,13,[16][17][18][19] However, other studies, which were not prospective and randomized, have assessed a possible link between the administration of HES and the development of pruritus. These studies show a very variable incidence of pruritus, varying between 0-54 %, [8][9][10][11][12][13][16][17][18][19][20] and a link between the total amount of HES infused and the incidence and severity of pruritus. 10,12,13,[16][17][18][19] In patients who are developing pruritus after HES administration, itching usually starts with a delay of 3 days to 15 weeks.…”

“…Kimme et al 12 have demonstrated in a retrospective study involving 37 patients operated for cerebral aneurysm and treated with 10% HES 200/0.5 (i.e., an average molecular weight of 200 kDa and a molar substitution of 0.5) that incidence and severity of pruritus were significantly higher for a total infused HES volume larger than 500 g. Total infused volume varied between 50 and 1,950 g and the global incidence of pruritus was 54%. Morgan et al 11 have also underlined this relationship.…”

“…In approximately 50% of cases, pruritus is so severe as to significantly compromise quality of life. 11,12,20 Pruritus crises vary between 2 and 30 minutes and they can occur months or years after administration of HES.…”

“…These studies show a very variable incidence of pruritus, varying between 0-54 %, [8][9][10][11][12][13][16][17][18][19][20] and a link between the total amount of HES infused and the incidence and severity of pruritus. 10,12,13,[16][17][18][19] In patients who are developing pruritus after HES administration, itching usually starts with a delay of 3 days to 15 weeks. Therefore, pruritus begins frequently after hospital discharge and may consequently go undetected.…”