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Dextran 40, a plasma volume expander, carries several risks that require careful consideration. One significant concern is the potential for severe allergic reactions, including anaphylactoid responses, which can lead to serious complications such as hypotension, cardiac arrest, or respiratory arrest. These reactions are more likely in individuals who have not been previously exposed to dextran and typically occur early during the infusion. Therefore, it is crucial to monitor patients closely during the initial stages of administration.

Another risk associated with Dextran 40 is circulatory overload. As a hypertonic colloid solution, it draws water from the extravascular space into the bloodstream, which can lead to vascular overload if administered excessively. This is particularly concerning for patients with impaired renal function, as they may have difficulty excreting the additional volume, increasing the risk of pulmonary edema and congestive heart failure. To mitigate this risk, careful clinical monitoring, preferably by assessing central venous pressure, is recommended.

Dextran 40 can also affect blood clotting mechanisms. In patients with normal hemostasis, doses approximating 15 mL per kilogram of body weight may prolong bleeding time and depress platelet function. These effects are more pronounced following trauma or major surgery, necessitating vigilant observation for early signs of bleeding complications. Additionally, dextran may interfere with blood typing and cross-matching procedures due to increased rouleaux formation, making it advisable to draw and reserve blood samples before initiating dextran therapy.

Furthermore, Dextran 40 can impact laboratory test results. For instance, blood sugar determinations that use high concentrations of acid may yield falsely elevated glucose levels due to dextran hydrolysis. Similarly, the presence of dextran in the blood can cause turbidity, interfering with assays such as bilirubin and total protein tests. To avoid these issues, it is recommended to withdraw blood for laboratory tests before starting dextran therapy.

Given these risks, Dextran 40 should be used with caution in patients with conditions such as diabetes mellitus, congestive heart failure, severe renal insufficiency, or those receiving corticosteroids or corticotropin. It is essential to ensure that the solution is clear and the container is undamaged before administration, and any unused portion should be discarded.