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Gelofusine

Modified fluid gelatin

Volume Therapy
Gelofusine

Worldwide tried and tested Efficient and reliable volume effect when compared
Gelofusine is a colloidal volume replacement fluid based on to modern HES 130
4% modified fluid gelatin. Due to the special molecular structure with negative charges
on the surface, Gelofusine results in an efficient and reliable
Several decades of experience in production and use of modified volume effect when compared to modern HES 130 products:
fluid gelatins recommend B. Braun as the partner of choice in Over the 6 hours following infusion, the magnitude and duration
the field of volume therapy. of the volume effect of 4% modified fluid gelatin was similar
compared to Voluven and significantly greater than volume
Over the years, B. Braun has put together an impressive track effect produced by 0.9% NaCl in healthy volunteers (Fig. 2)1.
record with Gelofusine with proven pharmaceutical quality
and demonstrated therapeutical value. Due to its stretched polypeptide chains and the negative charge,
retention of Gelofusine in the circulation is prolonged.
Important advantages in comparison with other gelatins make Like albumin, Gelofusine is repelled by negatively charged cap-
Gelofusine the most often used gelatin for modern volume illary endothelium and provide a colloid osmotic pressure (COP)
therapy. that is comparable with albumin for effective treatment of
hypovolemia (Fig. 3)3.

Fig. 1: Molecular shape of different types of gelatin. Compare 4.

Polypeptide chains of Small and globular


succinylated gelatin with strong polypeptide chains of
negative charge repel one another urea-linked gelatin

[ml] 700
Gelofusine (G) 4%
modified fluid gelatin
600
Change in blood volume

Voluven (V) 6% HES 130/0.4 0.4


Saline (S)
500
0.3
COP50/COP10 ratio

400

300 0.2

200
0.1
100

0 0
0 1 2 3 4 5 6 Urea-linked Human Gelofusine
Time [hours] Gelatin Albumin

Fig. 2: Changes in blood volume and extravascular fluid volume after infusion of Fig. 3: COP50 /COP10 ratios (as indicator for plasma retention). Adapted from3. .
5

1 litre of 0.9% saline (S), 4% modified fluid gelatin (G) and 6% HES 130 (V)
over 1 hour 1.

p values S vs G < 0.0001; S vs V < 0.0001; G vs V = 0.70


Voume Therapy

worldwide tried and tested

Not all gelatins are the same No risk of hyperchloremic acidosis


As you cannot compare apples and oranges it is as well misleading Some other gelatins contain a higher concentration of chloride,
to equate different kinds of gelatins. Gelatins differ in their main when compared to plasma. The additional chloride intake incre-
physicochemical properties which, in turn, have a significant impact ases the chloride level within the plasma and may lead to a
on clinical efficacy: hyperchloremic acidosis. Hyperchloremic acidosis may cause
postoperative confusion, headache, abdominal pain, nausea and
n Succinylated or modified fluid gelatin (MFG): MWw of 30,000 vomiting, thereby hindering the patients recovery4,5. Due to its
Dalton, characterized by long stretched polypeptide chains plasma-like chloride content (120 mmol/L), Gelofusine is not
and a significant negative charge created by the succinylation. associated with the above mentioned clinical consequences.
n Urea-linked gelatin or Polygelin: MWw of 35,000 Dalton, small

and globular polypeptide chains, that are crosslinked by urea


bridges, only slight negative charge.

Gelofusine is a modified fluid gelatin. Gelofusines polypeptide


chains have been stretched and negatively charged during the
succinylation process, so that they repel one another and occupy
considerably more space than other gelatins. These differences
result in a longer effect duration of Gelofusine compared to
other gelatins (Fig. 1 and Fig. 3)2,3.

Gelofusine product characteristics

Isotonic solution for plasma volume replacement User benefits


Active ingredient Modified fluid gelatin n Proven efficacy and safety with more than
Concentration 40 (4%) 2 million applications per year worldwide
Electrolytes: Sodium (mmol/l) 154 n Appropriate and reliable hemodynamic
Chloride (mmol/l) 120
stabilization
pH 7.4 0.3
Theoretical osmolarity n Compatible with blood and all blood
274
(mOsm/l) products
Volume effect 100% n No risks of hyperchloremic acidosis
Clinically relevant duration
4 hours
of volume expansion
Gelofusine
Composition Therapeutic Indications Special warnings and precautions for use Undesirable Effects
1000 ml solution contain: Colloidal plasma volume substitute for Gelofusine should be administered with caution After the administration of Gelofusine infusions,
to patients with a history of allergic diseases, e.g. just as of any colloidal volume substitutes, ana-
Succinylated gelatin Prophylaxis and treatment of relative asthma. phylactoid reactions of varying degrees of severity
(= modified fluid gelatin) 40.00 g or absolute hypovolaemia and of shock; may occur.
Prophylaxis of hypotension (e.g. during induction Gelofusine should only be administered with
(Molecular weight, of epidural or spinal anaesthesia); caution to The incidence of undesirable effects of
weight average: 30.000 Dalton - Procedures involving extracorporeal circulation Gelofusine is as follows:
Molecular weight, (e.g. heart-lung machine); - elderly patients Rare: anaphylactoid reactions all grades
number average: 23.200 Dalton) Acute normovolaemic haemodilution. - patients at risk due to circulatory overload e.g. Very rare: Severe anaphylactoid reactions
patients with congestive heart failure, right Uncommon: Transient mild nausea or abdominal
Sodium chloride 7.01 g Contraindications or left ventricular insufficiency, hypertension, pain, Transient mild rise of body temperature
Gelofusine must not be administered in case of: pulmonary oedema or renal insufficiency with
Electrolyte concentrations oligo- or anuria. B. Braun Melsungen AG
Sodium 154 mmol/l hypersensitivity to any of the constituents of 34212 Melsungen, Germany
Chloride 120 mmol/l the solution, In such cases Gelofusine should only be given
hypervolaemia, under careful monitoring of the patients
Theoretical osmolarity: 274 mOsm/I hyperhydration, haemodynamic situation.
pH: 7.4 0.3 severe cardiac insufficiency,
severe blood coagulation disorders.

Brandnames 4% MFG: Gelofusine, Physiogel CH , Gelafundin 4% D , Gelafundina E

1. Lobo DN:
Effect of volume loading with 1 liter intravenous infusions of 0.9% 4. Wilkes N J et al.:
saline, 4% succinylated gelatine (Gelofusine) and 6% hydroxyethyl starch The effects of balanced versus saline-based hetastarch and crystalloid
(Voluven) on blood volume and endocrine responses: a randomized, three-way solutions on acid-base and electrolyte status and gastric mucosal perfusion
crossover study in healthy volunteers. in elderly surgical patients
Crit Care Med. 2010 Feb; 38(2): 464-70 Anesth Analg 93 (2001) 811-816

2. Himpe D et al.: 5. Williams E L et al.:


Priming solutions for cardiopulmonary bypass: comparison of three colloids The effect of intravenous Lactated Ringers solution versus 0.9% sodium
Cardiothorac Vasc Anesth 5 (1991) 457-466 chloride solution on serum osmolarity in human volunteers
Anesth Analg 88 (1999) 999-1003
3. Webb A R et al.:
In vitro colloid osmotic pressure of commonly used plasma expanders
and substitutes: a study of the diffusibility of colloid molecules
Intensive Care Med 15 (1989) 116-120

B. Braun Melsungen AG | Hospital Care | 34209 Melsungen | Germany


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