Is transfusion of human albumin (HA) 20% indicated in the treatment of hypoglycemia?

Human Albumin 20% is Not Indicated for the Treatment of Hypoglycemia

Human albumin 20% is not indicated for the treatment of hypoglycemia and should not be used for this purpose. 1, 2 The standard treatments for hypoglycemia include oral carbohydrates for conscious patients and intravenous dextrose or glucagon for severe cases.

Standard Treatments for Hypoglycemia

First-line treatments:

• For conscious patients: Oral carbohydrates (15-20g of glucose)
• For unconscious patients or those unable to take oral carbohydrates:
  • Intravenous dextrose (typically D50W or D10W)
  • Glucagon (intramuscular, subcutaneous, or intranasal)

Evidence for standard treatments:

• Intravenous dextrose has been shown to be more efficacious than oral carbohydrates in treating severe hypoglycemia (blood glucose <50 mg/dL), with significantly higher rates of achieving euglycemia within 15-30 minutes 3
• Glucagon is an effective alternative when IV access is difficult or unavailable 4
• Intranasal glucagon has demonstrated efficacy in raising blood glucose levels in the prehospital setting, with 62% of patients showing substantial or slight improvement in mental status 5, 6

Why Human Albumin is Not Appropriate for Hypoglycemia

1. No physiological mechanism: Albumin does not contain glucose or stimulate glucose production, and thus has no direct role in treating hypoglycemia 2

2. Not supported by guidelines: Current transfusion medicine guidelines and critical care guidelines do not recommend albumin for treating hypoglycemia 1, 2

3. Specific indications for albumin are limited to:

   • Large-volume paracentesis (>5L) at a dose of 8g albumin/L of ascites removed 1
   • Spontaneous bacterial peritonitis with increased serum creatinine 1
   • Second-line fluid in septic shock when large volumes of crystalloids are required 1

4. Potential risks of inappropriate albumin use:

   • Fluid overload and pulmonary edema
   • Allergic reactions
   • Increased cost without clinical benefit 2

Special Considerations for Neonatal Hypoglycemia

While neonates are vulnerable to transfusion-associated hypoglycemia during blood transfusions, this is managed by:

• Maintaining constant glucose infusion rates during blood transfusions
• Monitoring blood glucose levels during transfusions
• Providing additional dextrose infusion as needed 1

Correct Management of Hypoglycemia

For mild to moderate hypoglycemia (conscious patient):

• Administer 15-20g of fast-acting carbohydrates orally
• Recheck blood glucose after 15 minutes
• Repeat treatment if blood glucose remains <70 mg/dL

For severe hypoglycemia (unconscious patient or unable to take oral carbohydrates):

1. First choice: IV dextrose (D50W 25-50mL in adults, D10W in children)
2. If no IV access: Glucagon 1mg IM/SC or intranasal glucagon 3mg
3. After regaining consciousness: Provide oral carbohydrates once the patient can safely swallow

Human albumin 20% should not be considered as part of the treatment algorithm for hypoglycemia as it has no role in glucose regulation and would delay appropriate therapy, potentially worsening outcomes.