How is hypoalbuminemia treated?

Treatment of 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 common in acute and chronic illness and is associated with greater morbidity compared to patients with preserved albumin levels 2
• Each 10-g/L decline in serum albumin concentration significantly raises the odds of mortality by 137%, morbidity by 89%, and prolongs intensive care unit and hospital stay 3
• Serum albumin may be a marker of inflammation rather than nutritional status in many acute conditions 2

Primary Treatment Approach

• Focus on treating the underlying cause of hypoalbuminemia rather than the low albumin level itself 2
• Provide adequate nutritional support, especially in malnourished patients 1, 2
• Address inflammation when present, as inflammatory conditions can suppress albumin synthesis 2
• Monitor serum albumin concentration regularly to assess improvement 2

Specific Clinical Scenarios Where Albumin Infusion May Be Considered

Liver Disease

• Albumin infusion is recommended for patients with cirrhosis undergoing large-volume paracentesis (>5L) to prevent paracentesis-induced circulatory dysfunction 1, 2, 4
• Albumin infusion is indicated for patients with spontaneous bacterial peritonitis 1, 2, 4
• For patients with hyponatremia and cirrhosis, the American Association for the Study of Liver Diseases suggests a trial of fluid restriction to 1,000 mL/day for moderate hyponatremia (120-125 mEq/L) 1

Shock and Critical Illness

• Albumin may be used as a second-line and adjunctive to crystalloids for fluid resuscitation in hypovolemic shock 1, 4
• For treatment of hypovolemic shock, the volume administered and speed of infusion should be adapted to the response of the individual patient 4
• The total dose should not exceed the level of albumin found in the normal individual (about 2 g per kg body weight) in the absence of active bleeding 4

Burns

• After a burn injury (usually beyond 24 hours), albumin may be used to maintain plasma albumin concentration around 2.5 ± 0.5 g per 100 mL 4
• The duration of therapy is decided by the protein loss from burned areas and in the urine 4

Dialysis Patients

• Albumin is not recommended for patients undergoing kidney replacement therapy for prevention or treatment of intradialytic hypotension 2
• For dialysis patients, a predialysis or stabilized serum albumin equal to or greater than the lower limit of normal range (approximately 4.0 g/dL) is the outcome goal 2

When Albumin Infusion Is Not Recommended

• Albumin infusion is not recommended for first-line volume replacement or to increase serum albumin levels in critically ill adult patients (excluding thermal injuries and ARDS) 2
• Albumin is not recommended in conjunction with diuretics for removal of extravascular fluid 2
• Simple albumin infusion and/or nutritional support did not significantly improve survival in patients with moderate to severe hypoalbuminemia 5

Administration Guidelines When Albumin Is Indicated

• Only 16 gauge needles or dispensing pins should be used with 20 mL vial sizes and larger 4
• Plasbumin-25 should always be administered by intravenous infusion, either undiluted or diluted in 0.9% Sodium Chloride or 5% Dextrose in Water 4
• If sodium restriction is required, Plasbumin-25 should only be administered either undiluted or diluted in a sodium-free carbohydrate solution such as 5% Dextrose in Water 4
• The rate of administration should not exceed 2 mL per minute in hypoproteinemic patients, as more rapid injection may precipitate circulatory embarrassment and pulmonary edema 4

Monitoring and Cautions

• Albumin infusion is expensive and has potential adverse effects including fluid overload, hypotension, hemodilution requiring RBC transfusion, anaphylaxis, and peripheral gangrene 2
• The patient's hemodynamic response should be monitored and the usual precautions against circulatory overload observed 4
• Hypoalbuminemia can affect drug pharmacokinetics, especially highly protein-bound medications, requiring therapeutic drug monitoring and potential dose adjustments 6

Common Pitfalls

• Focusing only on correcting albumin levels without addressing the underlying cause 1, 2
• Assuming hypoalbuminemia is solely due to nutritional deficiency when inflammation may be the primary driver 7, 2
• Using albumin infusion as a routine treatment for hypoalbuminemia without specific indications 1, 2
• Failing to monitor for fluid overload when administering albumin, especially in patients with compromised cardiac or renal function 2, 4