What are the potential side effects of administering large volumes of intravenous (IV) albumin?

Side Effects of Large Volumes of IV Albumin Administration

The most significant side effects of large volume IV albumin administration include fluid overload, pulmonary edema, hypotension, tachycardia, and allergic reactions, with these adverse events generally being dose-dependent. 1, 2

Common Adverse Effects

• Fluid overload and pulmonary edema are major risks, especially in patients with compromised cardiac or pulmonary function 2
• Hypotension and tachycardia can paradoxically occur despite albumin being used to treat hypovolemia 2, 1
• Allergic/anaphylactic reactions including urticaria, chills, fever, rash, pruritus, rigors, and changes in respiration, pulse and blood pressure 3, 2
• Hemodilution may occur, potentially requiring RBC transfusion to correct 2

Risk Factors for Adverse Events

• Cirrhotic patients are at higher risk for adverse effects due to increased capillary permeability and compromised lymphatic drainage capacity 2, 4
• Patients with extraperitoneal infections receiving albumin show higher rates of pulmonary edema 1
• Patients with pre-existing cardiac or pulmonary dysfunction are at increased risk for circulatory overload 2

Patient Population-Specific Complications

Critical Care Patients

• Albumin administration may not be effective for first-line volume replacement and can lead to adverse effects 2
• In patients with sepsis or shock, some studies suggest hyperoncotic albumin solutions may potentially worsen acute kidney injury, though overall evidence for this effect is limited 5

Patients with Cirrhosis

• Higher rates of pulmonary edema are observed in cirrhotic patients receiving albumin for extraperitoneal infections 1
• Circulatory overload is more common in patients with cirrhosis receiving albumin versus crystalloid 2
• The MACHT trial showed limitations including development of pulmonary edema and multiorgan failure in some cirrhotic patients 4

Serious but Rare Concerns

• Transmission of infectious agents: Although extremely rare with modern processing techniques, products made from human plasma theoretically carry risk of transmitting infectious agents, including viruses and the Creutzfeldt-Jakob Disease agent 3
• Severe hemolysis and acute renal failure may result if inappropriate diluents (such as Sterile Water for Injection) are used instead of recommended diluents like 0.9% Sodium Chloride or 5% Dextrose in Water 3

Monitoring Recommendations

• Watch for respiratory distress, pulmonary rales, and peripheral edema as signs of fluid overload 2
• Monitor for hypotension and tachycardia during infusion 2
• Be vigilant for allergic reactions including skin changes, fever, and rigors 2
• Observe for at least 4 hours after container has been entered, as partially used vials must be discarded 3

Practical Considerations

• Adverse events are generally dose-dependent, with higher doses carrying greater risk 1
• Cost of albumin should be weighed against potential risks and benefits 2
• Addressing underlying causes of hypoalbuminemia rather than simply infusing albumin is generally recommended when possible 2