What is the treatment approach for hypoalbuminemia?

Treatment Approach for Hypoalbuminemia

The treatment of hypoalbuminemia should focus on addressing the underlying cause rather than simply correcting the low albumin level, as albumin infusion is not recommended for routine treatment of hypoalbuminemia alone. 1

Understanding Hypoalbuminemia

• Hypoalbuminemia is a common finding in critically ill patients and is associated with higher morbidity and mortality rates 2
• Serum albumin concentration is determined by its rate of synthesis, catabolic rate, external losses, and redistribution between vascular and extravascular spaces 3
• Hypoalbuminemia is primarily a consequence of inflammation, which increases capillary permeability, expands the interstitial space, and shortens albumin half-life 4

Primary Treatment Approach

• Focus treatment on the underlying cause of hypoalbuminemia rather than the low albumin level itself 1, 5
• Provide adequate nutritional support, especially in malnourished patients, as recommended by the European Society of Gastrointestinal Endoscopy 1
• Monitor serum albumin as a parameter of clinical progress or deterioration, not as a direct treatment target 5
• Address inflammatory conditions, crystalloid overload, liver dysfunction, or protein losses that may be causing hypoalbuminemia 5

When Albumin Infusion May Be Considered

Albumin infusion may be appropriate in specific clinical scenarios:

• Liver disease complications:

  • Patients with cirrhosis undergoing large-volume paracentesis 1, 6
  • Patients with spontaneous bacterial peritonitis 1, 6
  • Patients with hepatorenal syndrome 6

• Other evidence-based indications:

  • Fluid replacement in plasmapheresis 6
  • As second-line and adjunctive to crystalloids for fluid resuscitation in specific conditions such as:
    • Intradialytic hypotension 1, 6
    • Severe burns 6
    • Major surgery 1, 6
    • Sepsis and septic shock (as adjunctive therapy) 6
    • Severe and refractory edema with hypoalbuminemia not responding to other treatments 6

Clinical Considerations and Cautions

• Base albumin infusion frequency and dosage on clinical indicators of hypovolemia rather than serum albumin levels 1
• For patients with hyponatremia and cirrhosis, consider a trial of fluid restriction to 1,000 mL/day for moderate hyponatremia (120-125 mEq/L) 1
• Albumin should not be used for nutritional purposes or simply to correct low albumin levels 6, 5
• Implementation of evidence-based guidelines in hospitals can reduce inappropriate uses of albumin 6
• Preoperative hypoalbuminemia (<30 g/L) is associated with a higher risk of postoperative intra-abdominal sepsis, highlighting the importance of addressing underlying causes before elective procedures 1

Common Pitfalls to Avoid

• Treating the laboratory value (low albumin) rather than the underlying condition 1, 5
• Assuming hypoalbuminemia is solely due to malnutrition when inflammation often plays a dominant role 4
• Using albumin infusion as first-line volume replacement in critically ill patients 1
• Failing to recognize that hypoalbuminemia develops slowly in response to malnutrition alone but occurs rapidly with inflammation or dilution with crystalloids 5