Hetastarch (Hydroxyethyl Starch): veterinary dose and monograph

At a glance

Drug class

Veterinary drug

Also known as

HES, Hydroxyethyl starch, Voluven, Hetastarch 6%

Species with doses

Dogs, Cats, Horses and Birds

Routes

IV

Last reviewed

1 October 2026

Indications

• Hypovolaemia / shock — colloid volume expansion (smaller volume, longer intravascular persistence)
• Support of colloid osmotic pressure in hypoalbuminaemia/hypoproteinaemia
• Situations where rapid, sustained plasma-volume expansion is desired (used cautiously)

Hetastarch (Hydroxyethyl Starch) dose by species

Doses are per administration unless stated. mg/kg doses scale with body weight; per-animal, per-quarter and infusion-rate doses are shown as the reference writes them.

Dogs

• Colloid volume expansion / COP support: Papich 5e: small-volume 5 mL/kg; large-volume 5–15 mL/kg; CRI 10–20 mL/kg/day (0.4–0.8 mL/kg/h); maximum 33–50 mL/kg/day or 70 mL/kg over 4 days. Plumb’s (Hetastarch): shock bolus 10–20 mL/kg; infusion 1–2 mL/kg/h not exceeding 20 mL/kg per 24 h (Hopper). Prolongs PT/aPTT; weigh renal and coagulation risks.

Cats

• Colloid volume expansion / COP support: Papich 5e: resuscitation 2–5 mL/kg; CRI 5–10 mL/kg/day (0.2–0.4 mL/kg/h). Plumb’s (Hetastarch): shock bolus 5–10 mL/kg; infusion not exceeding 10 mL/kg per 24 h. Rapid administration causes nausea and vomiting in cats; watch for volume overload.

Horses

• Colloid support / volume replacement: Papich 5e: 8–10 mL/kg bolus or 0.5–1 mL/kg/h. Plumb’s (Hetastarch): same; foals 3–5 mL/kg with crystalloids; do not exceed 10 mL/kg/day (coagulopathy).

Birds

• Colloid / shock resuscitation: Plumb’s (Hetastarch): 10–15 mL/kg over 20–40 min, max about 20 mL/kg/24 h; shock — hypertonic saline 3–5 mL/kg then hetastarch 3–5 mL/kg over 5 min (Antinoff); 3–5 mL/kg IV/IO over 10 min (Lennox).

Contraindications

Renal impairment / oliguric renal failure (AKI risk — a major concern). Coagulopathy/active bleeding or bleeding disorders (HES impairs coagulation dose-dependently). Congestive heart failure/fluid overload. Sepsis/critical illness where human data show harm (use cautiously). Known hypersensitivity. Exceeding the daily dose limit.

Species-specific warnings

Cats: Cats are sensitive to volume and coagulation effects — give small boluses slowly, monitor closely, and respect the daily dose ceiling.

Adverse effects

• Acute kidney injury (dose-related; the major human-data concern)
• Coagulopathy / impaired platelet function and clot strength (dose-dependent) — bleeding risk
• Anaphylactoid reactions; volume overload
• Pruritus (tissue accumulation, chronic use); interference with some lab tests

Drug interactions

• Anticoagulants/antiplatelets: additive bleeding tendency (HES itself impairs coagulation)
• Nephrotoxins: additive renal risk
• Laboratory assays: can interfere with some tests (e.g. amylase)
• Other volume expanders: additive volume overload

Pregnancy and lactation

Limited data; use cautiously and only if benefits outweigh the renal/coagulation risks.

Monitoring

• Renal function (before and during use — AKI risk)
• Coagulation / platelet function and bleeding signs (dose-dependent)
• Volume status / colloid osmotic pressure (if measured); daily dose total (≤ ~20 mL/kg/day)
• Anaphylactoid reactions during infusion

Toxicity and overdose

The two dose-dependent toxicities that define modern caution are ACUTE KIDNEY INJURY (osmotic nephrosis-type tubular injury — the reason for human restrictions) and COAGULOPATHY (impaired vWF/factor VIII and clot strength → bleeding). Volume overload, anaphylactoid reactions, and (with chronic use) refractory pruritus from tissue accumulation also occur. Respect the daily dose ceiling.

Management: Stop the infusion; supportive care. Manage volume overload (diuretics as needed), monitor renal function and coagulation, and support with appropriate crystalloids/blood products if bleeding. There is no specific antidote; avoid exceeding daily dose limits to prevent toxicity.

Clinical pearls

• A synthetic colloid that expands and holds plasma volume with less fluid than crystalloids — useful in shock/hypovolaemia and to prop up colloid osmotic pressure in hypoalbuminaemia
• BUT its risk profile has shifted: human trials link HES to acute kidney injury and coagulopathy, so use it more cautiously in animals — avoid in renal impairment/coagulopathy/sepsis and respect the daily dose limit
• Dose-dependent bleeding risk (impairs vWF/factor VIII/platelets) — watch coagulation, especially in cats and bleeding patients
• Not a substitute for blood products/albumin when those are truly indicated

Mechanism of action

Hydroxyethyl starch is a large, water-soluble polysaccharide (amylopectin-derived, hydroxyethyl-substituted to resist degradation) that remains largely within the vascular space and exerts colloid osmotic (oncotic) pressure, drawing/holding water in the vasculature to expand and sustain plasma volume with a smaller infused volume than crystalloids. Its large molecules are gradually broken down and cleared renally/reticuloendothelially; interference with von Willebrand factor/factor VIII and platelet function underlies its dose-dependent coagulation effects, and tubular/osmotic effects underlie the renal concern.

Formulations and products

• 6 % hydroxyethyl starch in saline (colloid)
• VetStarch (6 % HES 130/0.4) (Zoetis) — 6 % hydroxyethyl starch, IV colloid
• Voluven / Hetastarch 6 % — 6 % HES, IV colloid (human-label)

Storage

Bags: 15–25 °C, do not freeze; protect from light. Discard if turbid/discoloured.

Before you use this dose

Reference doses for veterinary professionals. Confirm the dose against the product label, the patient’s condition, current guidance and local regulations before use; the attending veterinarian remains responsible for every clinical decision.

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Frequently asked questions