PLASMA SUBSTITUTES 



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4 having the nephrotic stage of chronic glomerulo- 

 nephritis. Serum albumin and globulin fell in propor- 

 tion to increased plasma volume. There were no 

 changes in absolute amounts of chloride, sodium, po- 

 tassium, or nitrogen excretion. There were no essen- 

 tial changes of serum bicarbonate, chloride, sodium, or 

 potassium. 



Hueper and associates (56) gave intravenous or 

 intraperitoneal polyvinyl alcohol to dogs or rabbits. 

 This produced prolonged clotting time and increased 

 the erythrocyte sedimentation rate; there was also 

 anemia lasting up to 77 days. The anemia occurred 

 immediately and was attributed to the retention of 

 red ceils in lung capillaries, spleen, and lymph node 

 sinusoids with later destruction plus hydremia. Pro- 

 longed clotting time was attributed to mechanical 

 interference with the fibrin network. Platelets fell and 

 fibrinogen decreased in some instances. 



Semple (93) bled each of 10 dogs 45% of its blood 

 volume and replaced the blood removed with 5.7% 

 dextran in o.g% saline (Connaught Laboratories). 

 The changes in the albumin and globulin were due to 

 dilution only, but fibrinogen fell more than simple 

 dilution would explain. No evidence was found that 

 dextran retarded protein restoration. Leusen & Essex 

 (67) gave to rabbits 1 ml 'kg of 6% dextran. There 

 was clumping of leukocytes in the vessels seen by ear 

 chamber, with an initial decrease in white count. The 

 white count then exceeded the control at 105 min. By 

 1 75 min leukocytosis occurred with a predominance 

 of polvmorphonuclear leukocytes. During the original 

 leukopenia the polymorphonuclear leukocytes de- 

 creased strikingly with a relative increase in mononu- 

 clear cells. The same effects were seen during leuko- 

 cytosis of infection. One ml/kg body weight of 6% 

 acacia had much less leukopenic effect in rabbits. A 

 second injection of dextran 24 hours later had little 

 effect on white blood cell count or on clumping. 



Hepatic Function 



The effect of plasma expanders upon hepatic func- 

 tion has been studied by several authors. Reinhold 

 and associates (88) studied patients who received i 

 liter of 6 % Commercial Solvents Corporation dextran 

 or I liter of 3.5% PVP intravenously. Some received 

 a second infusion the following day. The following 

 liver function tests were performed : serum bilirubin, 

 thymol turbidity, zinc turbidity, phenol turbidity and 

 Bromsulphalein retention, and cephalin flocculation 

 test. These tests showed little change after either dex- 



tran or PVP. Scott & Howard (91 ) studied the hepatic 

 function of wounded patients following resuscitation 

 with plasma expanders. Hepatic function was studied 

 by means of plasma bilirubin, Bromsulphalein reten- 

 tion, urine urobilinogen, cephalin flocculation, and 

 thymol turbidity in nine patients resuscitated with 

 dextran and modified 3 % gelatin. As compared to 

 casualties receiving bank blood, no evidence of hepatic 

 functional impairment was found. Reinhold and 

 associates (88) studied 23 patients who received i, 2, 

 or 6 liter infusions of dextran; 15 additional patients 

 received i or 2 liters of polyvinylpyrrolidone intra- 

 venously. There were no significant changes in serum 

 bilirubin, cephalin flocculation, zinc sulphate 

 turbidity or Bromsulphalein retention, thymol tur- 

 bidity or flocculation, urine urobilinogen, urine 

 coproporphyrin, or serum globulin. 



Renal Function 



Also of interest has been the effect of plasma substi- 

 tutes upon renal function. Raisz (86) gave dogs 20 

 ml/kg body weight of either Expandex (Commercial 

 Solvents Corporation dextran, mol wt average 40,000) 

 or of 5% oxypolygelatin (Don Baxter, Inc., average mol 

 wt 20,000). There was an increase of glomerular filtra- 

 tion rate, effective renal plasma flow, and in excretion 

 of sodium, potassium, and water. The effects were 

 similar with dextran, oxypolygelatin, saline, and al- 

 bumin, except that albumin increased renal plasma 

 flow the most and saline the least. Greenman and asso- 

 ciates (42) studied the effect of the infusion of 375 to 

 1000 ml of ! 2 '~c sodium-free de.xtran in eight patients, 

 five of whom were edematous, four having the neph- 

 rotic state of chronic glomerulonephritis. Seven of the 

 eight .subjects developed increased urinary flow. There 

 were no changes in the absolute amounts of chloride, 

 sodium, potassium, or nitrogen excreted. In edema- 

 tous patients there was usually a negative water bal- 

 ance by the end of diuresis. The infusions were well 

 tolerated, except in one patient with congestive heart 

 failure who became dyspneic, and the infusion was 

 therefore discontinued. The authors concluded that 

 dextran was useful in the edema a.ssociated with 

 hypoproteinemia. Stamler and co-workers (95) in- 

 jected 200 ml of 6% dextran in water in i to 2 min in 

 dogs infused with Ringer's solution. In some experi- 

 ments there was a sustained increase of water, sodium, 

 and total solute diuresis. The glomerular filtration 

 rate was unchanged. Renal plasma flow was in- 

 creased; venous pressure rose and hematocrits fell. 



