What is the difference between Albumin 25% and Albumin 5% infusion?

Albumin 25% vs Albumin 5% Infusion: Key Differences and Clinical Applications

Albumin 25% is a hyperoncotic solution primarily used for its plasma-expanding effects without significant volume administration, while albumin 5% is iso-oncotic and used when both volume expansion and oncotic pressure increase are needed. 1

Concentration and Oncotic Properties

• 25% Albumin:

  • Hyperoncotic solution (25g albumin per 100mL)
  • Draws fluid from interstitial to intravascular space
  • Provides 5 times more albumin per volume compared to 5% solution
  • Minimal volume administration (100mL of 25% contains 25g albumin)
  • Indicated when fluid restriction is necessary

• 5% Albumin:

  • Iso-oncotic solution (5g albumin per 100mL)
  • Similar oncotic pressure to plasma
  • Provides volume expansion without significant fluid shift
  • Larger volume administration (500mL of 5% contains 25g albumin)
  • Used when both volume expansion and albumin replacement are needed

Clinical Applications

25% Albumin Indications

1. Large-volume paracentesis (>5L):

   • Recommended dose: 8g albumin/L of ascites removed (32mL of 25% solution per liter) 1
   • Prevents post-paracentesis circulatory dysfunction 2
   • Reduces risk of renal impairment, hyponatremia, and mortality 1

2. Spontaneous bacterial peritonitis:

   • Recommended dose: 1.5g/kg on day 1 and 1g/kg on day 3 1
   • Reduces rates of kidney impairment and mortality

3. Intradialytic hypotension:

   • Particularly in patients with hypoalbuminemia (<30g/L)
   • Superior to saline for maintaining blood pressure and improving ultrafiltration 2, 1

4. Cerebral edema management:

   • Creates oncotic gradient to withdraw cerebral interstitial fluid 3
   • May reduce intracranial pressure in patients with mild to moderate brain edema

5% Albumin Indications

1. Volume expansion in hypovolemic states:

   • Used when both volume and albumin replacement are needed
   • Less risk of fluid overload compared to crystalloids in certain patients

2. Plasma exchange procedures:

   • Replacement fluid during plasmapheresis 4

Administration Considerations

• Administration rate:

  • 25% albumin: Should not exceed 2mL per minute in patients with hypoproteinemia to avoid circulatory complications and pulmonary edema 1
  • 5% albumin: Can be administered more rapidly when volume expansion is needed

• Cost implications:

  • Albumin is expensive (approximately $130/25g in US dollars) 1
  • Inappropriate use represents significant healthcare costs (approximately $20,000 per patient annually) 1
  • 25% solution delivers the same amount of albumin in a smaller volume, potentially reducing administration costs

Common Pitfalls and Caveats

1. Avoid routine use for hypoalbuminemia correction:

   • Not recommended for routine correction of low serum albumin without specific indications 1, 4, 5
   • No survival benefit in critically ill patients with hypoalbuminemia without addressing underlying cause

2. Monitor for volume overload:

   • Exercise caution in patients with heart failure or cardiomyopathy 1
   • 25% solution carries lower risk of volume overload compared to 5% solution

3. Consider alternatives for volume expansion:

   • Crystalloids are first-line for most volume expansion needs
   • Reserve albumin for specific indications where evidence supports its use

4. Potential risks with hyperoncotic solutions:

   • Some studies suggest hyperoncotic albumin solutions may worsen AKI in sepsis or shock 6
   • However, overall evidence for this effect is weak

In conclusion, the choice between 25% and 5% albumin should be based on whether the primary goal is to increase oncotic pressure with minimal volume (25%) or to provide both volume expansion and oncotic support (5%). The 25% solution is particularly valuable in situations requiring fluid restriction or targeted oncotic effects, while the 5% solution is more appropriate when volume replacement is also needed.