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PLASMA EXPENDERS
FOR ALL OF U AND ESPECIALLY TESTY AND SHINER
I WOULD NEVER EVER FUCK WT THIS SHIT
WHAT IS PLASMA EXPENDER:
Plasma Expanders
Editors Note: Because of a certain coach (or more specifically a precontest drug array specialist) whose elite clientele finished in the top three places in all of the biggest pro shows, other bodybuilders cried foul play citing that these “supervised athletes” had an unfair advantage. The supervising coach responsible for pioneering the use of plasma expanders and taking the sport to another level turned out clients who weighed roughly the same as they did the previous year, However, they all appeared roughly 20lbs larger in their newly EXPANDED hyper saturated muscularture. With Ben Johnson-like speed, plasma infusion has rapidly trickeled from the pro ranks down to national qualifying level V contests. The immediate future of winning a national or pro level contest now appears to be contingent on the athlete’s guidance and/or medical knowledge of the latest chemical array of pharmacologics-PLASMA EXPANDERS!
Blood-Volume Expanders
John E. Clark, Pharm.D., FASHP
Because of the potential complications associated with diuretic use in athletes, major bodybuilding sponsors have begun drug-testing athletes for use of these agents. The biggest problem for athletes using diuretics is that they run the risk of dehydrating. Dehydration can cause faintness, dizziness, headaches, nausea, loss of coordination and balance, cramps, and in some cases, kidney and heart failure. You may recall several professional bodybuilders having to be carried off the stage due to severe and debilitating muscle cramps, and pain. I won’t mention any names, but you know who they are.
Now that diuretics have become banned substances, bodybuilders have sought to find alternative methods to display the lean, hard, and dry appearance often seen with diuretic use. One approach that has been used is the administration of blood-volume or plasma volume expander solutions. To explain how these products work, let me first explain how body water is normally distributed throughout the body.
Normally total body water (TBW) in males represents approximately 60% of body weight (see Figure 1). This percentage varies according to the relative amount of fat present, since fat cells contain small amounts of water. In females TBW approximates 50% of body weight. Thus, in a 75 kg male TBW equals 45 liters. This fluid is distributed into two compartments. Two-thirds (30 liters) is intracellular fluid (ICF). The extracellular fluid (ECF) is further subdivided with approximately 75% (11.25 liters) in the interstitial space and 25% (3.75 liters) in the plasmA. The plasma and intracellular fluid make up the intravascular space.
Blood-volume expanders are large molecular weight solutions, that once introduced into the body, they have the tendency to cause the osmotic movement of or "pull" water from the extracellular fluid compartment into circulation (i.e., into plasma and intracellular space). Since the water in the skin and muscle is extracellular water, some bodybuilders think that the administration of a blood-volume expander prior to a contest leads to a much more "dry", hard, and full appearance. Whether or not this is truly the case is very debatable and would require further study.
Blood-volume expanders have been used for more than 70 years in a variety of medical conditions to expand the intravascular volume. Although these products have been shown to be very effective in clinical practice in resuscitating the body with fluid, depending of the type used, their effect may be variable.
Medical Use of Blood-Volume Expanders
Hemorrhagic shock
Cardiopulmonary bypass
Septic shock
Obstetrics
Thermal injury
Vascular surgery
Organ transplantation
Liver disease
In general, there are two categories of intravenous products available for blood-volume expansion: crystalloids and colloids. A crystalloid is a substance in solution that can pass through a semipermeable membrane. Crystalloids are usually sugar or salt solutions (e.g., dextrose or saline) that contain some combination of electrolytes (e.g., sodium, chloride, potassium) and/or trace elements. Two of the most popular are normal saline and lactated Ringer's solutions.
Types of Crystalloid Solutions
Dextrose 5% in Water Injection
0.9% Sodium Chloride Injection
Normosol-R® Injection
Plasma-Lyte® Injection
Lactated Ringer's Injection
3% Sodium Chloride Injection
7.5% Sodium Chloride Injection
In general, crystalloids are inexpensive, easy to obtain and safe for fluid resuscitation in clinical practice. They work quickly and excess fluids can be easily eliminated through diuresis.
However, since they contain such small particle size (solutes), crystalloids rapidly leak out of the vasculature into the surrounding tissues and therefore, their effects do not last very long. Also large volumes are required to achieve the desired effect and this may cause edema in certain people. Crystalloids are usually not used by bodybuilders for "drying out" nor should they.
Crystalloids: Advantages and Disadvantages
Advantages
Inexpensive
Readily available
Low side effects
Rapid effect and removal
Disadvantages
Short half-life
Rapid distribution beyond plasma
Large amounts needed
May cause edema, metabolic alkalosis
A colloid is a substance in solution that cannot pass through a semipermeable membrane (e.g., veins). This category includes whole blood, plasma, packed red cells and the different types of prepared colloid solutions, both natural and synthetic. Albumin is an example of a natural colloid since its solutions contain a protein derived from human plasmA. Synthetic colloid solutions are made from sugar or starch molecules. Due to their large molecular size, they are capable of mimicking some of the properties of naturally occurring plasma proteins such as albumin.
Natural Colloid
Albumin
Synthetic Colloids
Hetastarch
Dextran 40
Dextran 70
Dextran 75
Albumin and the synthetic colloids seem to be the solutions most often used by bodybuilders for "drying out".
While they have their advantages and disadvantages (see Table 5), they also differ in the colloid oncotic pressure (COP) they exert. Oncotic pressure is something that's created from the forces of water to move across the cell membrane or from one compartment to another. This may be significant to bodybuilders because the amount of oncotic pressure a solution exerts determines, in a sense, the relative strength of these products. As shown in Table 6, hetastarch exerts a smaller COP than Dextran and albumin. Also, based on the half-life (T ½) (i.e., the time at which 50% of the solution is out of the body), hetastarch and albumin may stay in the body longer than Dextran. These factors, along with several others should be considered by bodybuilders prior to using these products. For example, if albumin is used it may exert a stronger oncotic effect than the other blood-volume expanders; consequently, this may seem attractive to some bodybuilders who may be retaining "excess" extracellular water prior to a contest. However, there are some precautions that should be taken when using albumin. Although the side effect profile is low, rapid infusion of albumin (> 10 mL/min) may produce a decrease in blood pressure (hypotension). Additionally, too rapid infusion could result in a too rapid expansion in plasma volume and this could result in "spillage" of fluid into other cavities (vascular overload), shortness of breath (dyspnea), and fluid in the lungs (pulmonary edema). Therefore, during plasma solution administration, blood pressure should be monitored and the infusion process should be slowed or discontinued if severe hypotension occurs. Because albumin has the tendency to also cause a quick and dangerous rise in blood pressure (hypertension) due to an increase in plasma volume, blood pressure should continue to be monitored during the solution administration process.
Colloids: Advantages and Disadvantages
Advantages
Disadvantages
Synthetic
Extended effect
May last too long
Available in bags for rapid infusion
Increased side effects
Not plasma-derived
May cause coagulopathy
Moderately priced
Maximum administration limit
Natural (albumin)
"Gold standard"
More expensive
Natural
Availability
Low side effects
Plasma-derived (safety?)
If hetastarch is used, the plasma volume only expands slightly in excess of the volume infused. The effects are seen very quickly. For example, one hour after infusing a 500-mL bag of hetastarch, plasma volume may expand to 1000 mL or less. To avoid vascular overload, the total amount and rate of infusion of hetastarch should not exceed 1500 mL/day and 20 mL/kg. of bodyweight. Although the "pulling" effects may be seen for several days, it is rapidly eliminated initially with over 40% eliminated from the body in the first 24 hours. However, because of how its large molecules are broken down in the body, the remainder of hetastarch may not be all eliminated for more than two weeks.
Hetastarch has the tendency to also cause vomiting, mild temperature elevation, chills, itching, and mild flu-like symptoms. These symptoms may be seen during administration and may be early signs of allergic reactions. If these occur, the hetastarch should be discontinued and if necessary antihistamines, such as diphenhydramine (Benadryl®) should be given.
The Dextrans are large branched chain sugar molecules that increase the plasma volume onefold to twofold over the volume used. To avoid fluid overload, administration of these solutions should not exceed 20 mL/kg/day. The Dextrans produce high oncotic pressure, which make them very effective in pulling fluid into the intravascular space. However, they are rapidly eliminated from the body with 50% of the low molecular weight dextrans being eliminated in 24 hours. They also have the tendency to cause allergic reactions (e.g., wheezing, tightness of the chest, shortness of breath, mild drop in blood pressure) and some time rare, severe and fatal anaphylactoid reactions (e.g., marked drop in blood pressure, cardiac and respiratory arrest). Bodybuilders attempting to use the Dextrans for "drying out" should be aware that these reactions occur early in the infusion period. While antihistamines may be effective in relieving the allergic reactions, the anaphylactoid reactions are considered emergencies and should be treated as such.
With the potential for the aforementioned side effects to occur, it is of great importance to always be monitored by a medical professional during the infusion process, especially if albumen or high oncotic inducing dextrans are administered.
It appears that bodybuilders have begun to experiment with blood-volume expanders in search of alternative methods to diuretics for "drying out." There are multiple colloidal solutions that can be used for blood-volume expansion. Each has their advantages and disadvantages and they differ in their individual properties.
Comparison of Blood-Volume Expanders
Expander
T ½
COP
(Colloid Oncotic Pressure)
Crystalloid
15 min
0
Hetastarch (Hespan®)
15 hrs
30 mmHg
Dextran 40
1 hr
60 mmHg
Dextran 70
1 hr
60 mmHg
Albumin 5%
16 hrs
20 mmHg
Albumin 25%
16 hrs
100 mmHg
The ideal colloid solution does not exist, but if it did, the desirable properties would be a solution that produces a sustained increase in plasma volume without posing a risk for developing side effects, such as edema, anaphylaxis, or infection. It would have the ability to be removed very quickly through diuresis. In addition, the solution would not interfere with the coagulation system or platelets.
Properties of an Ideal Blood-Volume Expander
Produces sufficient oncotic pressure
Intravascular dwelling time sufficient to achieve volume goals
Ability to remove (excess) volume through diuresis
Lack of interference with cellular or capillary functioning
Lack of interference with coagulation system or platelets
Free of antigenic or allergic properties and pose no infectious risk
While the use of blood-volume expanders in bodybuilding remains a controversial and heated topic of discussion, it is uncertain what course of direction the debate and the use of these products will take. These solutions certainly add an interesting twist in the evolution of the pharmacology involved in the bodybuilding. What was once a joke: “That guy probably hooks himself up to a IV at night,” is now reality.
One related note of importance is that most athletes feel that the addition of a diuretic is an integral point of the overall precontest fine tuning process. Consequently, in conjunction with plasma expanders, mannitol appears to be the preferred substance used to fine-tune the drying out process prior to competition. However, because it increases the risk of hypovolemia (a rapid drop in blood pressure), using mannitol in conjunction with blood volume expanders increases the potential for cardiovascular disaster.
I WOULD NEVER EVER FUCK WT THIS SHIT
WHAT IS PLASMA EXPENDER:
Plasma Expanders
Editors Note: Because of a certain coach (or more specifically a precontest drug array specialist) whose elite clientele finished in the top three places in all of the biggest pro shows, other bodybuilders cried foul play citing that these “supervised athletes” had an unfair advantage. The supervising coach responsible for pioneering the use of plasma expanders and taking the sport to another level turned out clients who weighed roughly the same as they did the previous year, However, they all appeared roughly 20lbs larger in their newly EXPANDED hyper saturated muscularture. With Ben Johnson-like speed, plasma infusion has rapidly trickeled from the pro ranks down to national qualifying level V contests. The immediate future of winning a national or pro level contest now appears to be contingent on the athlete’s guidance and/or medical knowledge of the latest chemical array of pharmacologics-PLASMA EXPANDERS!
Blood-Volume Expanders
John E. Clark, Pharm.D., FASHP
Because of the potential complications associated with diuretic use in athletes, major bodybuilding sponsors have begun drug-testing athletes for use of these agents. The biggest problem for athletes using diuretics is that they run the risk of dehydrating. Dehydration can cause faintness, dizziness, headaches, nausea, loss of coordination and balance, cramps, and in some cases, kidney and heart failure. You may recall several professional bodybuilders having to be carried off the stage due to severe and debilitating muscle cramps, and pain. I won’t mention any names, but you know who they are.
Now that diuretics have become banned substances, bodybuilders have sought to find alternative methods to display the lean, hard, and dry appearance often seen with diuretic use. One approach that has been used is the administration of blood-volume or plasma volume expander solutions. To explain how these products work, let me first explain how body water is normally distributed throughout the body.
Normally total body water (TBW) in males represents approximately 60% of body weight (see Figure 1). This percentage varies according to the relative amount of fat present, since fat cells contain small amounts of water. In females TBW approximates 50% of body weight. Thus, in a 75 kg male TBW equals 45 liters. This fluid is distributed into two compartments. Two-thirds (30 liters) is intracellular fluid (ICF). The extracellular fluid (ECF) is further subdivided with approximately 75% (11.25 liters) in the interstitial space and 25% (3.75 liters) in the plasmA. The plasma and intracellular fluid make up the intravascular space.
Blood-volume expanders are large molecular weight solutions, that once introduced into the body, they have the tendency to cause the osmotic movement of or "pull" water from the extracellular fluid compartment into circulation (i.e., into plasma and intracellular space). Since the water in the skin and muscle is extracellular water, some bodybuilders think that the administration of a blood-volume expander prior to a contest leads to a much more "dry", hard, and full appearance. Whether or not this is truly the case is very debatable and would require further study.
Blood-volume expanders have been used for more than 70 years in a variety of medical conditions to expand the intravascular volume. Although these products have been shown to be very effective in clinical practice in resuscitating the body with fluid, depending of the type used, their effect may be variable.
Medical Use of Blood-Volume Expanders
Hemorrhagic shock
Cardiopulmonary bypass
Septic shock
Obstetrics
Thermal injury
Vascular surgery
Organ transplantation
Liver disease
In general, there are two categories of intravenous products available for blood-volume expansion: crystalloids and colloids. A crystalloid is a substance in solution that can pass through a semipermeable membrane. Crystalloids are usually sugar or salt solutions (e.g., dextrose or saline) that contain some combination of electrolytes (e.g., sodium, chloride, potassium) and/or trace elements. Two of the most popular are normal saline and lactated Ringer's solutions.
Types of Crystalloid Solutions
Dextrose 5% in Water Injection
0.9% Sodium Chloride Injection
Normosol-R® Injection
Plasma-Lyte® Injection
Lactated Ringer's Injection
3% Sodium Chloride Injection
7.5% Sodium Chloride Injection
In general, crystalloids are inexpensive, easy to obtain and safe for fluid resuscitation in clinical practice. They work quickly and excess fluids can be easily eliminated through diuresis.
However, since they contain such small particle size (solutes), crystalloids rapidly leak out of the vasculature into the surrounding tissues and therefore, their effects do not last very long. Also large volumes are required to achieve the desired effect and this may cause edema in certain people. Crystalloids are usually not used by bodybuilders for "drying out" nor should they.
Crystalloids: Advantages and Disadvantages
Advantages
Inexpensive
Readily available
Low side effects
Rapid effect and removal
Disadvantages
Short half-life
Rapid distribution beyond plasma
Large amounts needed
May cause edema, metabolic alkalosis
A colloid is a substance in solution that cannot pass through a semipermeable membrane (e.g., veins). This category includes whole blood, plasma, packed red cells and the different types of prepared colloid solutions, both natural and synthetic. Albumin is an example of a natural colloid since its solutions contain a protein derived from human plasmA. Synthetic colloid solutions are made from sugar or starch molecules. Due to their large molecular size, they are capable of mimicking some of the properties of naturally occurring plasma proteins such as albumin.
Natural Colloid
Albumin
Synthetic Colloids
Hetastarch
Dextran 40
Dextran 70
Dextran 75
Albumin and the synthetic colloids seem to be the solutions most often used by bodybuilders for "drying out".
While they have their advantages and disadvantages (see Table 5), they also differ in the colloid oncotic pressure (COP) they exert. Oncotic pressure is something that's created from the forces of water to move across the cell membrane or from one compartment to another. This may be significant to bodybuilders because the amount of oncotic pressure a solution exerts determines, in a sense, the relative strength of these products. As shown in Table 6, hetastarch exerts a smaller COP than Dextran and albumin. Also, based on the half-life (T ½) (i.e., the time at which 50% of the solution is out of the body), hetastarch and albumin may stay in the body longer than Dextran. These factors, along with several others should be considered by bodybuilders prior to using these products. For example, if albumin is used it may exert a stronger oncotic effect than the other blood-volume expanders; consequently, this may seem attractive to some bodybuilders who may be retaining "excess" extracellular water prior to a contest. However, there are some precautions that should be taken when using albumin. Although the side effect profile is low, rapid infusion of albumin (> 10 mL/min) may produce a decrease in blood pressure (hypotension). Additionally, too rapid infusion could result in a too rapid expansion in plasma volume and this could result in "spillage" of fluid into other cavities (vascular overload), shortness of breath (dyspnea), and fluid in the lungs (pulmonary edema). Therefore, during plasma solution administration, blood pressure should be monitored and the infusion process should be slowed or discontinued if severe hypotension occurs. Because albumin has the tendency to also cause a quick and dangerous rise in blood pressure (hypertension) due to an increase in plasma volume, blood pressure should continue to be monitored during the solution administration process.
Colloids: Advantages and Disadvantages
Advantages
Disadvantages
Synthetic
Extended effect
May last too long
Available in bags for rapid infusion
Increased side effects
Not plasma-derived
May cause coagulopathy
Moderately priced
Maximum administration limit
Natural (albumin)
"Gold standard"
More expensive
Natural
Availability
Low side effects
Plasma-derived (safety?)
If hetastarch is used, the plasma volume only expands slightly in excess of the volume infused. The effects are seen very quickly. For example, one hour after infusing a 500-mL bag of hetastarch, plasma volume may expand to 1000 mL or less. To avoid vascular overload, the total amount and rate of infusion of hetastarch should not exceed 1500 mL/day and 20 mL/kg. of bodyweight. Although the "pulling" effects may be seen for several days, it is rapidly eliminated initially with over 40% eliminated from the body in the first 24 hours. However, because of how its large molecules are broken down in the body, the remainder of hetastarch may not be all eliminated for more than two weeks.
Hetastarch has the tendency to also cause vomiting, mild temperature elevation, chills, itching, and mild flu-like symptoms. These symptoms may be seen during administration and may be early signs of allergic reactions. If these occur, the hetastarch should be discontinued and if necessary antihistamines, such as diphenhydramine (Benadryl®) should be given.
The Dextrans are large branched chain sugar molecules that increase the plasma volume onefold to twofold over the volume used. To avoid fluid overload, administration of these solutions should not exceed 20 mL/kg/day. The Dextrans produce high oncotic pressure, which make them very effective in pulling fluid into the intravascular space. However, they are rapidly eliminated from the body with 50% of the low molecular weight dextrans being eliminated in 24 hours. They also have the tendency to cause allergic reactions (e.g., wheezing, tightness of the chest, shortness of breath, mild drop in blood pressure) and some time rare, severe and fatal anaphylactoid reactions (e.g., marked drop in blood pressure, cardiac and respiratory arrest). Bodybuilders attempting to use the Dextrans for "drying out" should be aware that these reactions occur early in the infusion period. While antihistamines may be effective in relieving the allergic reactions, the anaphylactoid reactions are considered emergencies and should be treated as such.
With the potential for the aforementioned side effects to occur, it is of great importance to always be monitored by a medical professional during the infusion process, especially if albumen or high oncotic inducing dextrans are administered.
It appears that bodybuilders have begun to experiment with blood-volume expanders in search of alternative methods to diuretics for "drying out." There are multiple colloidal solutions that can be used for blood-volume expansion. Each has their advantages and disadvantages and they differ in their individual properties.
Comparison of Blood-Volume Expanders
Expander
T ½
COP
(Colloid Oncotic Pressure)
Crystalloid
15 min
0
Hetastarch (Hespan®)
15 hrs
30 mmHg
Dextran 40
1 hr
60 mmHg
Dextran 70
1 hr
60 mmHg
Albumin 5%
16 hrs
20 mmHg
Albumin 25%
16 hrs
100 mmHg
The ideal colloid solution does not exist, but if it did, the desirable properties would be a solution that produces a sustained increase in plasma volume without posing a risk for developing side effects, such as edema, anaphylaxis, or infection. It would have the ability to be removed very quickly through diuresis. In addition, the solution would not interfere with the coagulation system or platelets.
Properties of an Ideal Blood-Volume Expander
Produces sufficient oncotic pressure
Intravascular dwelling time sufficient to achieve volume goals
Ability to remove (excess) volume through diuresis
Lack of interference with cellular or capillary functioning
Lack of interference with coagulation system or platelets
Free of antigenic or allergic properties and pose no infectious risk
While the use of blood-volume expanders in bodybuilding remains a controversial and heated topic of discussion, it is uncertain what course of direction the debate and the use of these products will take. These solutions certainly add an interesting twist in the evolution of the pharmacology involved in the bodybuilding. What was once a joke: “That guy probably hooks himself up to a IV at night,” is now reality.
One related note of importance is that most athletes feel that the addition of a diuretic is an integral point of the overall precontest fine tuning process. Consequently, in conjunction with plasma expanders, mannitol appears to be the preferred substance used to fine-tune the drying out process prior to competition. However, because it increases the risk of hypovolemia (a rapid drop in blood pressure), using mannitol in conjunction with blood volume expanders increases the potential for cardiovascular disaster.
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