What is the recommended dose of albumin (human albumin) and administration duration in hours?

Human Albumin Dosing Guidelines

The recommended dose of human albumin varies by clinical indication, with 8 g/L of ascites removed for large-volume paracentesis (>5L) and 1.5 g/kg followed by 1 g/kg on day 3 for spontaneous bacterial peritonitis being the most evidence-based regimens. 1, 2

Dosing Recommendations by Clinical Indication

Large-Volume Paracentesis (>5L)

• Dose: 8 g albumin per liter of ascites removed 1, 2
• Administration timing: Immediately after paracentesis completion 2
• Formulation: 20% or 25% albumin solution 1
• Evidence strength: High quality evidence with strong recommendation 2, 3

Spontaneous Bacterial Peritonitis (SBP)

• Dose: 1.5 g/kg within 6 hours of diagnosis, followed by 1 g/kg on day 3 1, 4
• Target population: Particularly beneficial in patients with increased serum creatinine or rising serum creatinine 1
• Rationale: Reduces risk of renal dysfunction by 72% and mortality by 47% 1, 4
• Note: Some small studies suggest lower doses may be effective, but the standard regimen has the strongest evidence 1

Hepatorenal Syndrome (HRS-AKI)

• Dose: 20-40 g/day alongside vasoconstrictors 1
• Duration: Optimal duration remains unclear, but continued until response 1
• Administration: Intravenous infusion 1

Severe Burns

• Dose: 1-2 g/kg/day for patients with >30% total burned body surface area 1
• Timing: After the first 6 hours of management 1
• Target: Maintain albumin levels >30 g/L 1
• Rationale: Decreases crystalloid administration and resulting morbidity 1

Acute-on-Chronic Liver Failure (ACLF)

• Dose: 6-8 g/L of ascites removed regardless of volume 1, 2
• Special consideration: Albumin administration recommended even for paracentesis <5L in these high-risk patients 2

Administration Guidelines

Rate of Administration

• Administer slowly to prevent circulatory overload 2
• Monitor for signs of volume overload, especially in patients with cardiac dysfunction 2

Monitoring Parameters

• Hemodynamic parameters
• Signs of volume overload
• Renal function
• Electrolytes 2

Clinical Considerations and Pitfalls

Common Pitfalls

1. Overuse in non-indicated conditions: Albumin should not be used routinely for:

   • Hypoalbuminemia without specific indications 3
   • Nutritional support 3
   • Infections other than SBP (unless associated with AKI) 1
   • Uncomplicated ascites with diuretics 1

2. Potential adverse effects:

   • Fluid overload
   • Pulmonary edema
   • Hypotension/tachycardia
   • Pyrexia
   • Rash/pruritus 1

3. Excessive dosing: Doses of HAS exceeding 87.5 g in SBP may be associated with worse outcomes due to fluid overload 1

Special Populations

• Pediatric burns patients: Early administration (8-12 hours post-burning) of 5% albumin decreases crystalloid requirements and fluid creep 1
• Patients with cardiac dysfunction: Require careful monitoring for volume overload 2

Conclusion

Human albumin dosing should be tailored to the specific clinical indication, with the strongest evidence supporting its use in large-volume paracentesis and spontaneous bacterial peritonitis. Administration should follow evidence-based protocols to maximize benefits while minimizing potential adverse effects.