Hespan
Hetastarch 6 percent in 0.9 percent sodium chloride
Brand names:Hespan
A synthetic colloid (hetastarch 6 percent in 0.9 percent sodium chloride) historically used for plasma volume expansion in hypovolemic shock. Hespan is the saline-carrier version; Hextend is the balanced-electrolyte version that was historically TCCC-preferred. Both are largely obsolete in current TCCC 2026 doctrine due to FDA boxed warnings for mortality and renal injury in critically ill patients and the operational rollout of cold-stored whole blood.
Pharmacology and Actions
Hespan is a synthetic colloid (hydroxyethyl starch, HES 670/0.75 - hetastarch). Large hetastarch molecules remain in the intravascular space, providing oncotic pressure and plasma volume expansion that lasts longer per volume than crystalloid. Theoretically allows resuscitation with smaller volumes - approximately 1:1 volume expansion versus 1:3 to 1:4 for crystalloid. Hetastarch impairs platelet function (acquired von Willebrand effect) and worsens coagulopathy in trauma.
Indications
- Historical volume expansion in hypovolemic shock (largely superseded by blood products)
- Plasma volume expansion in surgical and traumatic shock when blood not available
- Acute normovolemic hemodilution (specialty surgical use)
Absolute Contraindications
- Known hypersensitivity to hydroxyethyl starches
- Severe sepsis (FDA boxed warning - increased mortality and renal failure)
- Pre-existing renal dysfunction (especially oliguria or anuria)
- Patients undergoing renal replacement therapy
- Critically ill adults (FDA boxed warning)
- Severe hepatic disease
- Bleeding disorders
- Heart failure with pulmonary edema
Precautions and Side Effects
FDA boxed warnings (issued 2013, updated multiple times): increased mortality in critically ill adults including septic patients, increased renal injury and need for renal replacement therapy, increased bleeding due to coagulopathy. Other: pruritus (sometimes severe and persistent), anaphylactoid reactions, hyperchloremic acidosis (with Hespan specifically due to NaCl carrier). Pharmacologically isolated; clinically relevant interactions are physiologic (coagulopathy effect potentiates other anticoagulant therapy). Half-life 17 hours (initial), 48 hours (terminal). Renal excretion of low molecular weight fractions; reticuloendothelial uptake of larger fractions with tissue persistence for weeks to months. Limited pregnancy and lactation data. Avoid in pediatrics. Contraindicated in renal impairment, septic patients, and critically ill patients. Monitor renal function daily during therapy, coagulation parameters, hemoglobin/hematocrit, acid-base balance (chloride accumulation with Hespan specifically), and volume status. Maximum 1500 mL per 24 hours typical ceiling; higher doses associated with worsened coagulopathy and renal injury.
Adult Dosing
Pediatric Dosing
Not recommended in pediatrics due to safety concerns.
Pharmacokinetics
Peak Effect: Plasma volume expansion peaks at 2 to 4 hours.
Duration: Volume effect persists 24 to 36 hours (longer than crystalloid).
Storage and Handling
Store at room temperature (20 to 25 degrees C). Do not freeze. Protect from extreme temperatures. Discard if solution is discolored or contains particulate matter.
Reconstitution:
Available as ready-to-use 500 mL bags. No reconstitution required. Administer through standard IV tubing with filter as recommended by labeling.
TCCC and TECC Role
Hespan is largely obsolete in current TCCC 2026 doctrine. Historically, Hextend (the balanced-electrolyte hetastarch) was the TCCC preferred field resuscitation fluid for many years - the rationale was small volume, rapid plasma expansion, and reduced logistic burden compared with crystalloid. The FDA boxed warnings, accumulating evidence of harm in critically ill patients, and the operational rollout of cold-stored low-titer O whole blood and freeze-dried plasma have displaced hetastarch from TCCC doctrine. Current TCCC 2026 prioritizes whole blood, components, or plasma; crystalloid is acceptable when blood products are not available; hetastarch is no longer recommended.
Hespan and Hextend are legacy products with diminishing operational role. Hetastarch was the right answer in 2005 when freeze-dried plasma and cold-stored blood were not feasible at point of injury. With current logistics, blood products are achievable forward of role 2 in many tactical settings, and the doctrine has appropriately shifted. The remaining niche for hetastarch is essentially historical interest and as a backup fluid in austere settings where no blood product is available and crystalloid alone would require volumes incompatible with the operational situation. Even then, the risk profile (coagulopathy, renal injury, mortality signal in critically ill) makes its use a deliberate, documented decision rather than a default.
Treating Hespan or Hextend as a current best-practice resuscitation fluid. The doctrine has changed. Blood products are preferred when available; crystalloid is preferred when blood is not. Hetastarch is a third-line consideration at best. The other mistake is high-volume administration (over 1500 mL) - this is where coagulopathy becomes dangerous in trauma. The other mistake specific to Hespan (versus Hextend) is the NaCl carrier producing hyperchloremic acidosis in volumes that approach 2 to 3 L total resuscitation.
This drug profile is provided as educational reference material for trained medical providers. It is not medical advice, not a substitute for formal training, and not a substitute for current published guidelines or medical direction.
Drug administration is governed by your scope of practice, agency standing orders, medical director protocols, and applicable state and federal regulations. Controlled substances are subject to additional handling, accountability, and documentation requirements per DEA and state law. Always verify dosing, indications, contraindications, and route of administration against current published guidelines and your local protocols before administration.
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Penn Tactical Solutions publishes this reference for educational purposes. PTS does not provide medical direction and does not assume responsibility for clinical decisions made in the field. Clinical responsibility rests with the administering provider, their medical director, and their agency.
Educational reference for trained medical providers. Not medical advice. Not a substitute for formal training, current published guidelines, or medical direction. Drug administration is governed by your scope of practice, agency standing orders, medical director protocols, and applicable state and federal regulations. Controlled substances require additional storage, accountability, and documentation per DEA and state law.
In a medical emergency, call 911. This reference is not a substitute for emergency medical services.
Verify dosing, indications, and contraindications against current published guidelines and your local protocols before administration. Confirm content currency against the source citation. Penn Tactical Solutions does not provide medical direction. Clinical responsibility rests with the administering provider, their medical director, and their agency.
Hespan
| IV/IO | 500 to 1000 mL IV. Maximum 1500 mL per 24 hours in trauma. Infusion rate dictated by clinical need (typically 250 to 500 mL bolus, then reassess). (Volume expansion within minutes) |
| IM | None (None) |
| IN | None (None) |
| PO | None (None) |