Acetyl starch, a possible alternative to hydroxyethyl starch as a plasma volume expander

Objectives: Pharmacokinetics and tolerability of acetyl starch (ACS) in comparison to hydroxyethyl starch (HES) were investigated after repeated intravenous infusions. Methods and chohorts: A 500ml solution of ACS (n = 8) or HES (n = 9) was infused to male volunteers (Age 25-42 Years) over four hours on five consecutive days. Results: Comparing the pharmacokinetic parameters, marked differences were found between ACS and HES. A continuos increase of C-max, AUC(0-24) and t(1/2) over the five days caused by administration of HES was due to an accumulation of HES in serum. However, after administration of ACS all these parameters remained unaltered. The repeated infusion of 50g ACS did not cause any changes of the acid-base-status. The influence of ACS on the coagulation parameters was comparable to that of HES and due to dilution effects. The acetic acid concentration increased up to 2,96 +/- 0,67mg/dl following ACS infusion. The blood glucose concentration was not influenced by the infusion of HES or of ACS. The repeated ACS infusions were well tolerated. In contrast to HES, ACS did not accumulate in serum. Conclusion: According to these data ACS is an alternative to HES for volume replacement. Well-known side effects due to long storage of HES in tissues may not occur following application of ACS. However, the wide usage of ACS is restricted by the limited stability of ACS solutions at room temperature. ACS solutions are thus only stable during storage at lower temperatures.