High incidence of pruritus after large doses of hydroxyethyl starch (HES) infusions

Background: There are several studies indicating a correlation between trea tment with hydroxyethyl starch (HES) and pruritus. In order to see whether there is a possible dose-response relationship between HES and pruritus, we retrospectively studied 50 patients who had received HES in varying doses (cumulative dose 500-19500 ml) as hemodilution therapy after subarachnoid h emorrhage. Methods: Of 50 consecutive patients, 6 were excluded due to severe neurolog ical sequelae. A questionnaire was sent to the remaining 44 patients at 6 m onths (5-12 months) median (range) after the end of HES treatment. Results: We received answers from 37 patients, of whom 54% reported pruritu s. On average pruritus lasted for 15 weeks. There was significantly more pr uritus in patients who received more than 5000 ml of HES versus those who r eceived less than 5000 ml (1)= 0.023). Pruritus had a delayed onset and app eared as pruritic crises lasting for 2-30 min. It had a patchy distribution in most patients and no predilected locations. In 4 patients (20%) the pru ritus lasted longer than 21 weeks. Conclusion: Our study indicates that there is a dose-dependency for the inc idence of HES-induced pruritus, and that in some cases the pruritus may he severe and long-lasting.