From the Guidelines
Albumin replacement therapy is recommended for patients with specific clinical indications, such as spontaneous bacterial peritonitis (SBP), large volume paracentesis for cirrhotic ascites, and hepatorenal syndrome, rather than solely based on low albumin levels. The typical dose for SBP is 1.5 g albumin/kg within 6 hours of diagnosis, followed by 1 g/kg on day 3, as recommended by the guidelines on the management of ascites in cirrhosis 1. For large volume paracentesis, the dose is 8 g albumin/L of ascites removed 1.
Key Indications for Albumin Replacement Therapy
- Spontaneous bacterial peritonitis (SBP): 1.5 g albumin/kg within 6 hours of diagnosis, followed by 1 g/kg on day 3 1
- Large volume paracentesis for cirrhotic ascites: 8 g albumin/L of ascites removed 1
- Hepatorenal syndrome: 1 g/kg on day 1, then 20-40 g/day
Rationale for Albumin Therapy
The rationale for albumin therapy is to restore oncotic pressure, improve intravascular volume, and enhance transport of medications, hormones, and other substances. However, the underlying cause of hypoalbuminemia should always be addressed, as albumin replacement alone provides only temporary benefit without treating the primary condition.
Important Considerations
- Albumin should not be used routinely for hypoalbuminemia in critically ill patients, malnutrition, or nephrotic syndrome without specific complications.
- The dose and frequency of albumin administration should be determined by clinical response and albumin levels.
- Fluid overload has been reported in prospective studies of albumin in patients with cirrhosis and non-SBP infection, therefore, careful monitoring of serum creatinine and fluid status is recommended 1.