From the Guidelines
Treatment for an albumin level of 2.7 g/dL should focus on addressing the underlying cause while providing supportive care, and intravenous albumin infusions may be considered in specific cases such as spontaneous bacterial peritonitis (SBP) or hepatorenal syndrome (HRS), but not as a routine treatment for hypoalbuminemia. The primary approach involves identifying and treating the condition causing hypoalbuminemia, such as liver disease, kidney disease, malnutrition, or protein-losing enteropathy 1. For patients with cirrhosis and SBP, albumin administration is recommended at a dose of 1.5 g/kg on day 1 and 1 g/kg on day 3, in addition to antibiotics 1.
Key Considerations
- Nutritional support is essential, with a high-protein diet providing 1.2-1.5 g of protein per kg of body weight daily, unless contraindicated by certain conditions like hepatic encephalopathy.
- Patients should consume protein-rich foods such as eggs, meat, fish, dairy, and legumes.
- Treating edema, a common symptom of hypoalbuminemia, may require sodium restriction and diuretics like furosemide 20-40mg daily.
- Regular monitoring of albumin levels, renal function, and electrolytes is necessary to assess treatment effectiveness.
Albumin Administration
- Albumin administration is recommended in the management of patients with cirrhosis for select indications, such as large-volume paracentesis, paracentesis-induced circulatory dysfunction, SBP, and HRS 1.
- The use of albumin in patients with acute-on-chronic liver failure (ACLF) is not well defined, and its broader use as a resuscitation agent in critically ill patients with cirrhosis and/or ACLF is not recommended 1.
- Albumin can be associated with adverse consequences, including fluid overload, hypotension, hemodilution requiring RBC transfusion, anaphylaxis, and peripheral gangrene from dilution of natural anticoagulants 1.
Guidance
- The American Association for the Study of Liver Diseases (AASLD) recommends albumin administration in patients with cirrhosis and SBP, but not as a routine treatment for hypoalbuminemia 1.
- The International Collaboration for Transfusion Medicine Guidelines recommends the use of albumin in specific clinical scenarios, including complications of cirrhosis, intradialytic hypotension, volume resuscitation, and priming of cardiopulmonary bypass circuit 1.
From the Research
Treatment for Low Albumin Levels
The treatment for low albumin levels, such as an albumin level of 2.7, is primarily focused on addressing the underlying causes of hypoalbuminemia, rather than treating the low albumin level itself 2.
Underlying Causes of Hypoalbuminemia
Some of the underlying causes of hypoalbuminemia include:
- Protein energy malnutrition
- Crystalloid overload
- Inflammation
- Liver dysfunction
- Serous losses
Treatment Approaches
Treatment approaches may involve:
- Addressing malnutrition through adequate protein intake
- Managing liver dysfunction and associated complications
- Preventing and treating infections
- Correcting fluid overload and electrolyte imbalances
Use of Human Albumin Solutions
In certain cases, such as advanced liver disease, human albumin solutions (HAS) may be beneficial in improving outcomes and reducing complications 3, 4, 5, 6. However, the use of HAS should be judicious and based on individual patient needs, as it can be associated with adverse events and is a costly treatment option.
Specific Indications for Albumin Therapy
Albumin therapy may be indicated in specific situations, such as:
- Large-volume paracentesis
- Hepatorenal syndrome
- Spontaneous bacterial peritonitis
- Acute kidney injury
Monitoring and Management
Regular monitoring of albumin levels and clinical status is essential to guide treatment decisions and adjust therapy as needed 2.