The detrimental role of colloidal volume substitutes in severe ovarian hyperstimulation syndrome: a case report

Although. the mechanisms for the development of ovarian hyperstimulation sy ndrome (OHSS) are still not clear, the symptoms usually correlate with the levels of serum estradiol and ovarian enlargement. We report a case. where the clinical course was unusually prolonged. When menstrual bleeding had al ready occurred, serum estradiol was less than 10 pg/ml and the ovaries were almost normal in size, the patient developed pleural effusion and a signif icant alteration in blood-coagulation. This was most likely caused by an ov er-infusion of hydroxyethyl starch (HES) over 10 days. The pleural effusion contained high levels of HES, reaching 74% of the plasma concentration as measured by a novel method after acidic hydrolysis of HES. Carbohydrates as dextran and HES are well known to interact with the blood-coagulation syst em. Increase capillary permeability, typical of OHSS, leads to loss of coll oidal substances into the third space, where HES is slowly degraded and osm otic pressure is high. This might prolong and aggravate the urine of OHSS. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.