[Excessive tissue storage of colloids in the reticuloendothelial system]

In addition to renal elimination and gastrointestinal metabolism (amylase; splenic and hepatic dextranase) colloid plasma solutions like dextran and hydroxyethyl starch deposit in tissues, especially in the reticuloendothelial system (RES). This tissue storage is limited in time (weeks to months), is influenced by the employed solution and other factors (lysosomes) and has usually no clinical importance (no RES blockade). We report here a case study of a patient with sepsis (lung, liver and kidney failure) who had an overload of the RES with colloids while being treated with dextran (molecular weight 40,000 and 70,000 daltons) and hydroxyethyl starch (mw 450,000 daltons, molar substitution 0,7) for 5 weeks. Autopsy showed parenchymal and reticuloendothelial cells of liver, lung, kidney and spleen with a large amount of colloid mass inclusions and altered organ morphology. This storage may have impaired ventilation, transport of bile acids and renal function. A possible role of tissue storage of colloids in organ failure is discussed.