Which of the following colloids is MOST associated with acute kidney injury in septic patients and is no longer recommended for volume resuscitation in sepsis?

• A 4% Human albumin solution
• B Gelatins (succinylated gelatin, polygeline)
• C Dextran 70
• D Hydroxyethyl starch (HES 130/0.4) ✓

Explanation

Hydroxyethyl starch solutions (especially HES 130/0.4) are associated with increased risk of acute kidney injury, need for renal replacement therapy, and mortality in septic patients, as demonstrated by the 6S and CHEST trials. The European Medicines Agency suspended HES products for critically ill and sepsis patients. Albumin is used selectively (e.g. spontaneous bacterial peritonitis, hepatorenal syndrome). Gelatins lack large RCT evidence for harm but are also increasingly avoided. Dextrans cause coagulopathy and anaphylaxis.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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