From the Guidelines
Albumin is primarily used to treat conditions such as spontaneous bacterial peritonitis, hepatorenal syndrome, and hepatic encephalopathy, as well as hypovolemia and hypoalbuminemia, with the goal of reducing morbidity, mortality, and improving quality of life. The use of albumin in these conditions is supported by recent studies, including a 2024 guideline from the International Collaboration for Transfusion Medicine Guidelines 1 and a 2024 practice guidance from the American Association for the Study of Liver Diseases (AASLD) 2.
Conditions Treated with Albumin
- Spontaneous bacterial peritonitis: administer 1.5g/kg on day 1 and 1g/kg on day 3 1
- Hepatorenal syndrome: use vasoconstrictors and albumin (20–40 g/day) for patients who fulfill the diagnostic criteria for Stage 2 or greater HRS-AKI and who do not have contraindications 2
- Hepatic encephalopathy: albumin may assist with the resolution or prevention of hepatic encephalopathy and may reduce mortality, with a typical dose of 1.5 g/kg/d for up to 10 days 1
- Hypovolemia and hypoalbuminemia: albumin should be administered for hypovolemic shock when crystalloids are insufficient, severe hypoalbuminemia (serum albumin <2.5 g/dL) with complications like edema or ascites 1
Dosage and Administration
- The typical dose is 25g (100mL of 25% solution) infused over 30-60 minutes, which can be repeated based on clinical response and albumin levels 1
- For large volume paracentesis, give 6-8g albumin per liter of ascitic fluid removed 1
- For spontaneous bacterial peritonitis, administer 1.5g/kg on day 1 and 1g/kg on day 3 1
Precautions and Contraindications
- Albumin should be used cautiously in patients with heart failure, pulmonary edema, or severe anemia 1
- It is contraindicated in those with severe allergic reactions to albumin or hypersensitivity to the preparation 1
From the FDA Drug Label
Emergency Treatment of Hypovolemic Shock Removal of ascitic fluid from a patient with cirrhosis may cause changes in cardiovascular function and even result in hypovolemic shock. Burn Therapy Hypoproteinemia With or Without Edema Adult Respiratory Distress Syndrome (ARDS) Cardiopulmonary Bypass Acute Liver Failure Neonatal Hemolytic Disease Sequestration of Protein Rich Fluids Erythrocyte Resuspension Acute Nephrosis Renal Dialysis
The conditions treated with albumin include:
- Hypovolemic shock
- Hypoproteinemia with or without edema
- Burn therapy
- Adult Respiratory Distress Syndrome (ARDS)
- Cardiopulmonary bypass
- Acute liver failure
- Neonatal hemolytic disease
- Sequestration of protein rich fluids
- Erythrocyte resuspension
- Acute nephrosis
- Renal dialysis [3] [4]
From the Research
Conditions Treated with Albumin
- Liver disease, including hepatorenal syndrome, spontaneous bacterial peritonitis, and large-volume paracentesis, have a moderate to high quality of evidence and a strong recommendation for administering albumin 5
- Fluid resuscitation in hypovolemic shock, sepsis and septic shock, severe burns, toxic epidermal necrolysis, intradialytic hypotension, ovarian hyperstimulation syndrome, major surgery, non-traumatic brain injury, extracorporeal membrane oxygenation, acute respiratory distress syndrome, and severe and refractory edema with hypoalbuminemia has a low to moderate quality of evidence and weak recommendation to use albumin 5
- Modest volume paracentesis, severe hyponatremia in cirrhosis has a low to moderate quality of evidence and a weak recommendation for albumin administration 5
- Ascites, with albumin therapy having documented advantages in its management 6
- Burns, hypoproteinaemia, and emergency treatment of shock, which are licensed indications for human albumin solutions 7, 8, 9
- Hypovolaemia, with some studies suggesting no evidence that albumin administration reduces the risk of death, and a strong suggestion that it may increase the risk of death 7, 8, 9
Albumin Administration
- The use of albumin should be based on evidence-based guidelines, and its administration should be tailored to the specific clinical situation 5
- Albumin should not be used in hypoalbuminemia or for nutritional purposes 5
- The quality of evidence and strength of recommendations for each albumin indication should be determined using a system such as GRADE 5