Administration of Intravenous Albumin
Intravenous albumin should be administered by slow infusion, with rates not exceeding 2 mL per minute to prevent circulatory overload and pulmonary edema, particularly in patients with normal blood volumes. 1
General Administration Guidelines
Route and Preparation
- Always administer albumin by intravenous infusion 1
- Can be administered either undiluted or diluted in:
- 0.9% Sodium Chloride
- 5% Dextrose in Water
- For patients requiring sodium restriction, administer undiluted or diluted in sodium-free solutions (e.g., 5% Dextrose in Water) 1
Administration Rate
- Standard rate: Not exceeding 2 mL per minute for hypoproteinemic patients 1
- Slower rates may be necessary for patients at risk of circulatory overload
- Always monitor patients carefully during administration to prevent circulatory overload 1
Specific Clinical Scenarios and Dosing
Cirrhosis with Large-Volume Paracentesis (>5L)
- Dose: 6-8 g albumin per liter of ascitic fluid removed 2
- Timing: Administer during or immediately after paracentesis 3
- For patients with acute-on-chronic liver failure: Administer 6-8 g/L regardless of amount of ascites removed 3
Spontaneous Bacterial Peritonitis (SBP)
- Standard dose: 1.5 g/kg on day 1, followed by 1 g/kg on day 3 3, 2
- Alternative lower dose regimen: 10 g/day for days 1-3 (has shown efficacy in smaller studies) 3
- Patients with jaundice (bilirubin >4 mg/dL) and/or AKI at baseline are most likely to benefit 3
Hypovolemic Shock
- Dose and infusion speed should be adapted to individual patient response 1
- Used as second-line therapy after crystalloids 4
Compatibility and Contraindications
Compatible with:
- Whole blood and packed red cells
- Standard carbohydrate and electrolyte solutions for IV use 1
Incompatible with:
- Protein hydrolysates
- Amino acid solutions
- Solutions containing alcohol 1
Monitoring and Precautions
During Administration:
- Monitor for signs of circulatory overload:
- Increased blood pressure
- Distended neck veins
- Pulmonary edema
- Dyspnea 1
Special Considerations:
- In dehydrated patients, albumin must be given with or followed by additional fluids 1
- In hemorrhage, supplement albumin with whole blood transfusion to prevent hemodilution 1
- Rapid blood pressure rise may occur, requiring careful observation for bleeding from previously undetected vessels 1
Common Pitfalls and Caveats
Inappropriate Use: Albumin is not recommended for routine treatment of hypoalbuminemia alone or as nutritional support 3, 2
Excessive Infusion Rate: Administering too quickly can precipitate circulatory embarrassment and pulmonary edema 1
Overuse in Non-Indicated Conditions: Evidence does not support routine use in:
- Most ICU patients (excluding specific indications)
- Infections other than SBP
- Correction of hypoalbuminemia without specific clinical indications 3
Adverse Events: Monitor for potential complications including:
- Fluid overload
- Pulmonary edema
- Hypotension/tachycardia
- Nausea/vomiting
- Rigors, pyrexia, rash/pruritus 3
By following these evidence-based administration guidelines, clinicians can optimize the therapeutic benefits of intravenous albumin while minimizing potential risks and complications.