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Interactions between the volume effects of hydroxyethyl starch 130/0.4 and Ringer´s acetate

Robert G Hahn12*, Christian Bergek1, Tobias Gebäck3 and Joachim Zdolsek1

Author Affiliations

1 Department of Anaesthesia, Faculty of Health Sciences, Linköping University, Garnisonsvägen, 58185 Linköping, Sweden

2 Research Department, Södertälje Hospital, Rosenborgsgatan 6-10, 152 40 Södertälje, Sweden

3 Department of Mathematical Sciences, Chalmers University of Technology, Maskingränd 2, 412 58 Gothenburg, Sweden. (The street addresses are really not needed for mail to reach any of these institutions

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Critical Care 2013, 17:R104  doi:10.1186/cc12749

Published: 29 May 2013



The turnover of Ringer´s solutions is greatly dependent on the physiological situation, such as the presence of dehydration or anaesthesia. The present study evaluates whether the kinetics is affected by previous infusion of colloid fluid.


Ten male volunteers with a mean age of 22 years underwent three infusion experiments, on separate days and in random order. The experiments included 10 mL/kg of 6% hydroxyethyl starch 130/0.4 (Voluven™), 20 mL/kg of Ringer's acetate, and a combination of both, where Ringer´s was administered 75 minutes after the starch infusion ended. The kinetics of the volume expansion was analysed by non-linear least- squares regression, based on urinary excretion and serial measurement of blood haemoglobin concentration for up to 420 minutes.


The mean volume of distribution of the starch was 3.12 L which agreed well with the plasma volume (3.14 L) estimated by anthropometry. The volume expansion following the infusion of starch showed monoexponential elimination kinetics with a half-life of two hours. Two interaction effects were found when Ringer´s acetate was infused after the starch. First, there was a higher tendency for Ringer´s acetate to distribute to a peripheral compartment at the expense of the plasma volume expansion. The translocated amount of Ringer´s was 70% higher when HES had been infused earlier. Second, the elimination half-life of Ringer´s acetate was five times longer when administered after the starch (88 versus 497 minutes, P <0.02).


Starch promoted peripheral accumulation of the later infused Ringer´s acetate solution and markedly prolonged the elimination half-life.

Trial registration NCT01195025

pharmacokinetic model; i.v. fluids, hydroxyethyl starch