What is the correction, dosing frequency, and duration for treating hypoalbuminemia?

Treatment of Hypoalbuminemia: Correction, Dosing Frequency, and Duration

Albumin infusion is not recommended for routine treatment of hypoalbuminemia alone; instead, treatment should focus on addressing the underlying cause rather than simply correcting the low albumin level. 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
• Hypoalbuminemia results from the combined effects of inflammation and inadequate protein and caloric intake in patients with chronic disease 3
• In the postoperative period, serum albumin levels typically decrease by 10-15 g/L due to suppressed synthesis from inflammatory cytokines and transcapillary loss 2

Primary Treatment Approach

• Focus on treating the underlying cause of hypoalbuminemia rather than the low albumin level itself 2, 3
• Provide adequate nutritional support with protein intake of 1.2-1.3 g/kg body weight/day, especially in malnourished patients 2, 4
• Address inflammation when present, as it is a major driver of hypoalbuminemia 3, 5

When Albumin Infusion May Be Considered (Specific Clinical Scenarios)

• Large-volume paracentesis: Recommended for patients with cirrhosis undergoing large-volume paracentesis (>5L) at a dose of 8g albumin/L of ascites removed 1, 4
• Spontaneous bacterial peritonitis: Recommended for patients with spontaneous bacterial peritonitis, particularly with increased serum creatinine 1, 4
• Burns: After burn injury (usually beyond 24 hours), aim to maintain plasma albumin concentration at 2.5 ± 0.5 g/dL with plasma oncotic pressure of 20 mm Hg 6
• Severe hypoproteinemia: For adults, the usual daily dose is 50 to 75 g and for children 25 g, administered at a rate not exceeding 2 mL per minute 6

When Albumin Infusion Is Not Recommended

• Not recommended for critically ill adult patients (excluding thermal injuries and ARDS) for first-line volume replacement or to increase serum albumin levels 2, 4
• Not recommended for neonatal and pediatric critical care for routine use 4, 7
• Not recommended for patients undergoing cardiovascular surgery 1, 4
• Not recommended for patients with cirrhosis for treatment of hypoalbuminemia or extraperitoneal infections 1
• Not recommended for patients undergoing kidney replacement therapy for prevention or treatment of intradialytic hypotension 1, 4

Administration Guidelines When Albumin Is Indicated

• Plasbumin-25 should always be administered by intravenous infusion, either undiluted or diluted in 0.9% Sodium Chloride or 5% Dextrose in Water 6
• For patients with severe hypoproteinemia, the rate of administration should not exceed 2 mL per minute, as more rapid injection may precipitate circulatory embarrassment and pulmonary edema 6
• In patients with hypovolemic shock, the volume administered and speed of infusion should be adapted to the individual patient's response 6

Monitoring Recommendations

• Monitor serum albumin concentration regularly (at least every 4 months in chronic conditions) 2
• Evaluate serum albumin levels in the context of the patient's overall clinical status 2
• Consider measuring positive acute-phase proteins (e.g., C-reactive protein) to identify inflammation in patients with low serum albumin 2

Potential Adverse Effects of Albumin Infusion

• Fluid overload is a potential adverse effect of albumin transfusion 4
• Hypotension can occur during administration 4
• Hemodilution requiring RBC transfusion may be necessary 4
• Anaphylaxis is a rare but serious potential adverse effect 4
• Peripheral gangrene from dilution of natural anticoagulants can occur 4

Common Pitfalls and Caveats

• Assuming hypoalbuminemia is solely due to nutritional deficiency when inflammation may be the primary driver 2, 5
• Simply administering albumin to critically ill patients with hypoalbuminemia has not been shown to improve survival or reduce morbidity in most cases 3, 8
• Albumin is expensive (approximately $130/25g USD) compared to other interventions 2, 4
• In patients with increased capillary permeability, albumin supplementation may lead to greater albumin leakage across the capillary membrane, contributing to edema formation without improvement in outcome 7
• Serum albumin may be a marker of inflammation rather than nutritional status in many acute conditions 2