What dose of albumin (human albumin) is used to raise blood oncotic pressure?

Albumin Administration for Raising Blood Oncotic Pressure

The appropriate dose of albumin to raise blood oncotic pressure is 0.5-1.0 g/kg, administered as 25% albumin solution via slow intravenous infusion at a rate not exceeding 2 mL per minute to prevent circulatory complications.

Mechanism of Action and Function

Albumin is the most abundant circulating protein, providing approximately 70% of plasma oncotic pressure 1. Its primary functions include:

• Maintaining plasma colloid oncotic pressure
• Binding and transporting endogenous and exogenous compounds
• Antioxidant properties
• Modulation of inflammatory and immune responses

When administered intravenously, hyperoncotic albumin (25% solution) expands plasma volume by recruiting fluid from the interstitial space. Research shows that each milliliter of 20% albumin can recruit approximately 3.4 mL of fluid from tissues 2.

Dosing Guidelines for Raising Oncotic Pressure

Standard Dosing:

• For hypoproteinemia: 0.5-1.0 g/kg administered as 25% albumin solution 3
• For adults: 50-75 g daily is the typical dose 3
• For children: 25 g daily is the typical dose 3

Administration Considerations:

• Administer via slow intravenous infusion
• Rate should not exceed 2 mL per minute in patients with hypoproteinemia to prevent circulatory embarrassment and pulmonary edema 4, 3
• Can be administered undiluted or diluted in 0.9% sodium chloride or 5% dextrose in water 3
• If sodium restriction is required, administer undiluted or diluted in sodium-free solutions like 5% dextrose 3

Clinical Indications for Albumin Administration

Albumin is indicated for raising oncotic pressure in specific clinical scenarios:

1. Cirrhosis with ascites:

   • 6-8 g of albumin per liter of ascites removed during large-volume paracentesis (>5L) 4, 5
   • Prevents post-paracentesis circulatory dysfunction

2. Spontaneous bacterial peritonitis:

   • 1.5 g/kg on day 1 and 1 g/kg on day 3 4, 5
   • Reduces rates of kidney impairment and mortality

3. Hypoproteinemia with edema:

   • When clinical signs indicate hypoproteinemia with fluid volume overload 3
   • May be combined with diuretics

4. Adult Respiratory Distress Syndrome (ARDS):

   • When clinical signs indicate hypoproteinemia with fluid overload 3
   • Combined with diuretics

Contraindications and Precautions

• Not recommended for routine treatment of hypoalbuminemia without specific indications 5, 4
• Use with caution in patients with:
  • Heart failure
  • Risk of volume overload
  • Pre-existing cardiomyopathy 4
• Monitor closely for signs of:
  • Pulmonary edema
  • Circulatory overload
  • Hypotension
  • Hemodilution requiring RBC transfusion 5

Monitoring Parameters

When administering albumin to raise oncotic pressure, monitor:

• Vital signs, particularly blood pressure
• Signs of volume overload (pulmonary edema, peripheral edema)
• Serum albumin levels
• Renal function
• Electrolyte balance

Efficacy Considerations

The effectiveness of albumin for raising oncotic pressure varies by clinical context:

• In critically ill patients, albumin shows no clear superiority over crystalloids for fluid resuscitation 5
• In patients with cirrhosis, albumin has demonstrated benefits for specific indications 5
• In patients with traumatic brain injury, albumin may be associated with higher mortality 5

Cost and Resource Considerations

Albumin is expensive (approximately $130/25g in US dollars) 5, making appropriate use essential. Inappropriate use represents a significant cost to healthcare systems, highlighting the importance of following evidence-based guidelines 4.