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HANDBOOK OF PHYSIOLOGY ^^ CIRCULATION I 



interference with blood typing or crossmatching. The 

 authors stated that the advantages of these plasma 

 substitutes were that there was no Rh factor sensitiza- 

 tion, no hepatitis, and no reaction due to hemolysis 

 or contaminated blood. Bloom (12) (115) treated with 

 dextran 52 patients in shock. There was no difficulty 

 in blood typing, crossmatching, or Rh determinations 

 in 27 patients with dextran blood levels ranging from 

 421 to 3000 mg/ioo ml. Sedimentation rates were in- 

 creased in relation to dextran blood level, returning 

 to normal when blood dextran level fell. There was 

 no proteinuria, or abnormal urinary sediment, and 

 the blood NPN did not change. After 500 ml of 6% 

 dextran, the mean plasma level was 726 mg/ioo ml, 

 falling slowly to a mean of 88 mg at 96 hours. Jenkins 

 and associates (63) used PVP for hypotension in 24 

 patients. The amount used was 500 to 1000 ml which 

 was usually given in 20 to 120 min. Twenty of 24 pa- 

 tients showed a satisfactory response — a sustained rise 

 in blood pressure if no longer bleeding, or a steady 

 blood pressure if still bleeding. Twelve of the 24 pa- 

 tients did not require blood after PVP. One patient 

 who received 500 ml PVT in 1 5 min developed pulmo- 

 nary edema. Arden and associates (5) gave 3.8% PVP 

 to 37 patients in shock. The blood pressure effects 

 were favorable and there were no untoward reactions. 

 Cordice and associates (23) used PVP Macrose (3.5% 

 P\'P in Ringer's solution) as an emergency treatment 

 of 38 cases of traumatic and hemorrhagic shock due 

 to head injury, fractures, and penetrating wounds of 

 the chest and abdomen. Some of these patients re- 

 quired blood and plasma later. In all instances there 

 was good clinical response with rise of blood pressure, 

 slowing of pulse, rise of pulse pressure, improvement 

 of vital signs, decrease of hematocrit, and plasma pro- 

 teins. No sensitivity or toxicity was seen. No inter- 

 ference with blood typing or coagulability occurred. 

 The volumes used were 500 to 2500 ml. 



Plasma substitutes have also been employed in the 

 treatment of edema associated with nephrosis. Dick 

 and associates (26) treated four children with nephro- 

 sis by means of intravenous acacia. One patient 

 showed at first some loss of edema but later failed to 

 respond. In a second case at first marked edema re- 

 duction occurred. Two other cases showed similar 

 temporary improvement, with fall in serum proteins 

 and hepatic enlargement accompanying the acacia 

 infusion. Autopsy findings in one patient showed 

 acacia in the liver, spleen, kidneys, lungs, lymph 

 nodes, and bone marrow; the liver containing 3.9% 

 acacia, the plasma 2.1 %, pericardial fluid 0.6%, 

 peritoneal fluid i.i ""J, and bile 2'^'c. The authors con- 



cluded that acacia in the treatment of nephrosis 

 was not of value and was associated with undesirable 

 results. Greenman and associates (42) treated eight 

 patients with 375 to 1000 ml of 12 % sodium-free dex- 

 tran given over a period of 88 to 350 min. Five of 

 these patients were edematous, four witii the neph- 

 rotic stage of chronic glomerulonephritis. After the 

 dextran infusion, the plasma volume increased 34 to 

 67 Tc and was still elevated at 20 to 24 hours, although 

 it began to fall at 3 hours. The serum albumin and 

 globulin fell in proportion to the increased plasma 

 volume. Seven of the eight patients had increased 

 urinary flow, but no change in the absolute amounts of 

 chloride, sodium, potassium, or nitrogen e.xcreted. 

 In edematous patients there was usually a negative 

 water balance ijy the end of the diuresis. The infusions 

 were well tolerated except in one patient with con- 

 gestive heart failure who became dyspneic, and the 

 infusion was discontinued. The authors concluded 

 that dextran is useful in the edema associated with 

 hypoproteinemia. James and co-workers (62) gave 

 12*^' dextran (Commercial Sohents Corporation) 

 in water to 16 children with the nephrotic syndrome. 

 The children received 300 to 400 ml per m- daily or 

 on alternate daNs. All save one lost weight. Three or 

 more daily infusions in 1 3 children produced signifi- 

 cant loss of edema in 9 and virtually complete diuresis 

 in 6. The edema recurred rapidly in all subjects; the 

 maximum period of remission was i month. The 

 infusions increased plasma volume 25 to 50%. There 

 was a decrease of serum sodium and potassium, and a 

 decrease of total serum osmolarity. Water, sodium, 

 and chloride diuresis was produced. 



SUMMARY 



Plasma substitutes are of potential importance in 

 the treatment of shock under circumstances where 

 adequate supplies of blood or plasma are not avail- 

 able, such as in remote areas or in casualties involving 

 a large segment of the population. The plasma 

 expanders are also useful tools for the study of the 

 physiologic effect of anemia and of hypervolemia. 

 The substances discussed in this chapter: gum arable 

 (acacia), gelatin, pectin, polyvinyl alcohol, poly- 

 vinylpyrrolidone, and dextran are each capable of 

 producing expansion of plasma volume witli attendant 

 decline in hematocrit and plasma proteins, and 

 increase of the red cell sedimentation rate, and of 

 increasing the blood pressure in animals or patients 



