A patient treated with hydroxyethyl starch (HES) may develop a chronic pruritus that is difficult to treat. Diagnosis may be difficult if a history of HES infusion is not given.


Proposed mechanism: deposition of starch within cutaneous nerves


The severity of pruritus is dose-dependent but can occur in some patients after a low dose.


Pruritus associated with HES:

(1) It may start 3-6 weeks after an infusion of HES..

(2) The pruritus may be localized or generalized and may be severe.

(3) The pruritus may be intractable and poorly responsive to standard therapy.

(4) It may severely impact the patient’s quality of life.

(5) It may last for a year or more.


If the cause is unrecognized then the patient may receive additional infusions of HES, resulting in a long-term condition.


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