Albumin

# albumin ## Overview - **Classification**: Plasma volume expander, blood product. - **Mechanism**: Increases plasma oncotic pressure, shifting fluid from interstitial to intravascular space; also binds/transports various substances. ## Primary Indications 1. **Hypovolemic Shock** - To restore circulating blood volume in situations like hemorrhage, trauma, burns. 2. **Hypoalbuminemia** - For severe albumin deficiency when crystalloids are insufficient or contraindicated. 3. **Large-volume Paracentesis** - To prevent post-paracentesis circulatory dysfunction. 4. **Spontaneous Bacterial Peritonitis (SBP)** - Adjunctive therapy to reduce renal impairment incidence. 5. **Hepatorenal Syndrome (HRS)** - Adjunctive therapy for Type 1 HRS. ## Adult Dosing ### Standard Dosing **Hypovolemic Shock / Burns** - **Dose**: Individualized; initially **25 g** (e.g., 500 mL of 5% solution or 100 mL of 25% solution). - **Frequency**: Repeat as needed based on patient response and hemodynamics. - **Route**: Intravenous (IV) infusion. - **Special Notes**: 5% solution for volume replacement, 25% for fluid restriction. **Hypoalbuminemia (Oncotic Support)** - **Dose**: **25-100 g** per day. - **Frequency**: Daily or as needed, based on clinical status. - **Route**: Intravenous (IV) infusion. - **Special Notes**: Avoid targeting specific albumin levels unless clinically indicated. **Large-volume Paracentesis (>5 Liters removed)** - **Dose**: **6-8 g** per liter of ascetic fluid removed. - **Frequency**: Administer during or immediately after paracentesis. - **Route**: Intravenous (IV) infusion. **Spontaneous Bacterial Peritonitis (SBP) - Adjunctive** - **Dose**: **1.5 g/kg** on day 1, then **1 g/kg** on day 3. - **Frequency**: Once on day 1, once on day 3. - **Route**: Intravenous (IV) infusion. ### Dose Adjustments - **Renal Impairment**: No specific adjustment. Monitor fluid status closely to avoid overload. - **Hepatic Impairment**: No specific adjustment. Often used for complications of liver disease. - **Elderly Patients**: No specific adjustment. Monitor fluid status carefully due to increased risk of heart failure. ## Pediatric Dosing ### Neonates (0-28 days) - **Hypovolemia / Hypoalbuminemia**: **0.5-1 g/kg/dose** (e.g., 2-4 mL/kg of 25% solution). - **Frequency**: Every 8-12 hours as needed. - **Maximum**: Monitor for fluid overload. - **Special Notes**: Administer slowly over 1-2 hours; use cautiously due to risk of fluid overload. ### Infants (1-12 months) - **Hypovolemia / Hypoalbuminemia**: **0.5-1 g/kg/dose** (e.g., 2-4 mL/kg of 25% solution or 10-20 mL/kg of 5% solution). - **Frequency**: Every 8-12 hours as needed. - **Maximum**: **25 g** per dose; total daily dose should not exceed adult limits without careful assessment. ### Children (1-12 years) - **Hypovolemia / Hypoalbuminemia**: **0.5-1 g/kg/dose** (e.g., 2-4 mL/kg of 25% solution or 10-20 mL/kg of 5% solution). - **Frequency**: Every 8-12 hours as needed. - **Maximum**: **25 g** per dose in most acute settings; up to **100 g/day** for severe hypoalbuminemia. ### Adolescents (13-18 years) - **Dose**: Generally follow adult dosing guidelines. - **Maximum**: **100 g/day** for severe hypoalbuminemia; **25 g** per dose for acute volume expansion. ## Safety Information ### Contraindications - **Absolute**: History of allergic reactions to albumin preparations. - **Relative**: Severe anemia, cardiac failure (risk of exacerbation). - **Relative**: Renal insufficiency (risk of fluid overload). ### Common Adverse Effects - **Common (1-10%)**: Flushing, urticaria, fever, chills, nausea. - **Less Common (<1%)**: Headache, rash, tachycardia, hypotension. - **Serious but Rare**: Anaphylactic reaction, circulatory overload, pulmonary edema. ### Key Drug Interactions - **ACE Inhibitors**: May increase risk of hypotension if given concurrently with rapid albumin infusion. - **Loop Diuretics**: May be co-administered to manage fluid overload, monitor electrolytes. - **No significant direct drug-drug interactions**: Primarily a volume expander. ## Monitoring & Follow-up - **Before Treatment**: Baseline vital signs, serum albumin, electrolytes, renal function. - **During Treatment**: Vital signs (BP, HR, RR) every 15-60 min initially, fluid balance, urine output, CVP if available. - **Clinical Signs**: Monitor for signs of fluid overload (dyspnea, crackles, edema). Watch for allergic reactions (rash, wheezing). ## Clinical Pearls - 💡 **Administration Rate**: Administer 5% albumin solution at **2-4 mL/min**. 25% albumin solution at **1 mL/min** (faster rates for emergencies). - 💡 **Fluid Overload Risk**: Higher with 25% solution. Monitor closely, especially in cardiac or renal patients. - 💡 **No Specific Albumin Goal**: Limited evidence supports targeting specific serum albumin levels. Treat underlying cause. - 💡 **Hypocalcemia**: Rapid or large infusions may cause hypocalcemia due to citrate. Monitor calcium levels. > **⚠️ Important**: This information is for educational purposes only. Always consult current prescribing information, local guidelines, and clinical judgment before prescribing.