What is the appropriate dose of human albumin for a patient?

From the Guidelines

The recommended dose of human albumin for adults is 1.5 g/kg on day 1 and 1 g/kg on day 3, as indicated for patients with spontaneous bacterial peritonitis (SBP) 1. This dosing strategy is supported by recent guidelines and studies, which emphasize the importance of albumin administration in preventing renal dysfunction and reducing mortality in patients with SBP 1. Key considerations for albumin dosing include:

• The dose should be individualized based on the patient's condition, body weight, and clinical response.
• In critical situations, higher doses may be necessary, but careful monitoring is essential to avoid fluid overload.
• For patients undergoing large volume paracentesis, a dose of 6-8 g of albumin per liter of ascites removed is recommended to prevent post-paracentesis circulatory dysfunction (PPCD) 1.
• In patients with hepatorenal syndrome, albumin is often used in conjunction with vasoconstrictors, with a recommended dose of 20-40 g/day 1. It's crucial to monitor the patient's hemodynamic status, fluid balance, and serum albumin levels during administration to ensure safe and effective use of albumin. Some key points to consider when administering albumin include:
• The infusion rate should be carefully controlled to avoid excessive fluid administration.
• Patients with cirrhosis and uncomplicated ascites should not receive albumin unless they have SBP or are undergoing large volume paracentesis.
• The use of albumin in patients with cirrhosis and infections other than SBP is not recommended, unless associated with acute kidney injury (AKI).

From the FDA Drug Label

The dosage of ALBURX 25, Albumin (Human) 25% solution is based on the principles outlined in the section on INDICATIONS AND USAGE but should always be adapted to the individual situation. The quantities required may be underestimated because of hidden extravascular deficits, and the effect of ALBURX® 25 infusion on the serum protein level should therefore be checked by laboratory analysis Volume Deficit The appropriate ALBURX® 25, Albumin (Human) 25% solution dose for the treatment of a volume deficit should be estimated from the recipient's hemodynamic response, supplemented with the established safeguards against a circulatory overload. In the absence of active hemorrhage, the total dose should at any rate not exceed the normal circulating albumin mass, i. e. 2 g per kg body weight. Oncotic Deficit The appropriate ALBURX® 25, Albumin (Human) 25% solution dose in grams of protein for the correction of an oncotic deficit can, as an average, be estimated from the difference between the desired and the actual TSP level x plasma volume (~40 mL/kg) × 2, Hemolytic Disease of the Newborn The appropriate ALBURX® 25, Albumin (Human) 25% solution dose for the binding of free serum bilirubin in severely hemolytic infants is 1 g/kg body weight, to be given about one hour prior to the exchange transfusion

The appropriate dose of human albumin for a patient depends on the individual situation and the specific indication for use.

• For volume deficit, the dose should not exceed 2 g per kg body weight.
• For oncotic deficit, the dose can be estimated from the difference between the desired and actual TSP level.
• For hemolytic disease of the newborn, the dose is 1 g/kg body weight. 2

From the Research

Appropriate Dose of Human Albumin

The appropriate dose of human albumin for a patient depends on the specific indication and clinical context.

• For fluid replacement in plasmapheresis and liver diseases, including hepatorenal syndrome, spontaneous bacterial peritonitis, and large-volume paracentesis, albumin administration has a moderate to high quality of evidence and a strong recommendation 3.
• For fluid resuscitation in hypovolemic shock, sepsis and septic shock, severe burns, toxic epidermal necrolysis, intradialytic hypotension, ovarian hyperstimulation syndrome, major surgery, non-traumatic brain injury, extracorporeal membrane oxygenation, acute respiratory distress syndrome, and severe and refractory edema with hypoalbuminemia, albumin administration has a low to moderate quality of evidence and a weak recommendation 3.
• The use of 20% human albumin solution is preferred over the 4% solution due to its increased plasma expansion and lower sodium load per gram of albumin 4.
• The use of 25% human albumin solution may be effective in managing ascites in patients with cirrhosis and reducing the volume of fluids administered 5.

Concentration of Albumin

• Human albumin is available as a 4% or 20% solution, with the latter being a more effective plasma expander and having a lower sodium load per gram of albumin 4.
• The choice of albumin concentration should be based on the specific clinical context and the patient's individual needs.

Clinical Context

• Albumin administration is most indicated in the management of cirrhosis complications, such as hepatorenal syndrome and spontaneous bacterial peritonitis 3.
• Albumin may be used as a second-line and adjunctive to crystalloids for fluid resuscitation in hypovolemic shock, sepsis and septic shock, and other critically ill patients 3, 6.
• The use of albumin should be guided by evidence-based guidelines and should be monitored closely to minimize adverse effects 3, 5.