Concentrated Albumin (25%) Dosing for Hypoalbuminemia
For patients with hypoalbuminemia, 25% albumin solution should be administered at a dose of 20-40 g/day (80-160 mL/day), with duration determined by clinical response and volume status after 1-2 days of treatment. 1
Dosing Guidelines
Standard Dosing Approach
- Initial dose: 20-40 g/day (80-160 mL of 25% solution)
- Administration rate: Not exceeding 2 mL per minute to avoid circulatory complications and pulmonary edema 1
- Duration: Evaluate after 1-2 days based on patient's volume status and clinical response
Clinical Considerations for Dosing
- Severity of hypoalbuminemia
- Underlying cause (cirrhosis, nephrotic syndrome, critical illness)
- Volume status of the patient
- Cardiac function (use caution in patients with heart failure)
Special Clinical Scenarios
Cirrhosis with Ascites
- Large-volume paracentesis (>5L): 8 g albumin/L of ascites removed (32 mL of 25% solution per liter removed) 2, 1
- Spontaneous bacterial peritonitis: 1.5 g/kg on day 1 and 1 g/kg on day 3 2, 1
- Acute-on-chronic liver failure: 6-8 g/L of ascites removed 1
Critical Illness
- Not recommended as first-line therapy for volume replacement or to routinely correct low serum albumin levels in critically ill patients 2
- Exception: Patients with thermal injuries and ARDS may benefit from albumin administration 2
Monitoring and Safety
Parameters to Monitor
- Serum albumin levels
- Volume status (vital signs, urine output, edema)
- Cardiac function (signs of volume overload)
- Renal function
Potential Complications
- Fluid overload
- Hypotension
- Pulmonary edema
- Anaphylaxis (rare)
- Peripheral gangrene from dilution of natural anticoagulants 2
Important Caveats
- Simple albumin infusion alone does not improve survival in patients with hypoalbuminemia without addressing the underlying cause 3
- Albumin administration is expensive (approximately $130/25g in US dollars) 2
- Evidence does not support routine use of albumin for hypoalbuminemia without specific indications 1
- Hypoalbuminemia affects drug pharmacokinetics, particularly for highly protein-bound medications, which may require dose adjustments 4
Practical Administration Tips
- Administer via slow intravenous infusion
- Monitor for signs of fluid overload during administration
- For patients with cardiac issues, administer more slowly and monitor cardiac status closely
- Consider the underlying cause of hypoalbuminemia and treat accordingly rather than just correcting the albumin level
Remember that treating the underlying cause of hypoalbuminemia is more important than simply correcting the albumin level, as simple albumin infusion without addressing the primary disease has not been shown to significantly improve outcomes 3.