Do NOT Mix Albumin with Sterile Water
Albumin should NEVER be diluted with sterile water alone for intravenous administration, as this can cause severe hemolysis and acute renal failure, which can be fatal. 1
Acceptable Diluents for Albumin
When dilution of 25% albumin is necessary, use ONLY:
- 0.9% Sodium Chloride (Normal Saline) - preferred option
- 5% Dextrose in Water - acceptable alternative when sodium load is a concern
Why Sterile Water is Dangerous
Sterile water alone creates a hypotonic solution that reduces the osmolarity of the albumin preparation. When this hypotonic solution enters the bloodstream, it causes:
- Severe hemolysis (red blood cell destruction)
- Acute renal failure
- Death (documented fatal cases)
Clinical Evidence of Harm
Between 1994-1998, the CDC documented 10 episodes of hemolysis (including one fatal case) in patients who received 25% albumin diluted with sterile water alone. These cases occurred during therapeutic plasma exchange when hospitals attempted to create 5% albumin solutions due to commercial shortages. 2
Critical Safety Points
The FDA drug label explicitly warns: "Severe hemolysis and acute renal failure may result from the inappropriate use of Sterile Water for Injection as a diluent for Albumin (Human), 25%." 1
Additional Administration Guidelines
- Do not use solutions that have been frozen
- Do not use if turbid
- Discard if not administered within 4 hours of opening the vial
- Discard partially used vials
- Never use cracked or previously opened vials
- Albumin 25% contains no preservative and must be administered intravenously
Common Pitfall to Avoid
The most dangerous error occurs when clinicians or pharmacists attempt to dilute concentrated (25%) albumin to create a lower concentration (5%) solution and mistakenly use sterile water because they want to avoid sodium load or simply due to lack of awareness. Always verify the diluent is either normal saline or 5% dextrose before mixing. 2