What is the recommended dosing and indication for albumin (human albumin) administration?

Recommended Dosing and Indications for Human Albumin Administration

Human albumin should be administered at 6-8 g/L of ascites fluid removed for large-volume paracentesis (>5L) and at 1.5 g/kg on day 1 followed by 1 g/kg on day 3 for spontaneous bacterial peritonitis in cirrhotic patients. 1

Primary Indications for Albumin Administration

Large-Volume Paracentesis

• Recommended dose: 6-8 g per liter of ascites fluid removed for paracentesis >5 liters 1
• For patients with low-severity cirrhosis, a half dose (4 g/L) may be effective and safe 1
• Should be administered slowly to prevent cardiac overload, especially in patients with preexisting cardiomyopathy 1
• Limit ascites removal to less than 8 liters during a single paracentesis procedure to reduce paracentesis-induced circulatory dysfunction (PICD) risk 1
• Reduces risk of PICD by 61% compared to alternative treatments 1
• Reduces hyponatremia risk by 42% and mortality by 36% 1

Spontaneous Bacterial Peritonitis (SBP)

• Recommended dose: 1.5 g/kg on day 1 and 1 g/kg on day 3 in combination with antibiotics 1
• Reduces incidence of renal impairment (10% vs 33%) and death (22% vs 41%) compared to antibiotics alone 1
• May be most beneficial for high-risk patients (serum bilirubin >4 mg/dL or serum creatinine >1 mg/dL) 1
• Careful assessment of volume status, cardiovascular status, and kidney function is advised before administration 1

Hepatorenal Syndrome

• Used in combination with vasoconstrictors (typically terlipressin) 1, 2
• Recommended dose: 1 g/kg before initiating vasoconstrictor treatment, then 20-40 g/day 1
• Duration of treatment and hemodynamic objectives remain empirical 1

Secondary Indications

Hypovolemic Shock

• Volume and speed of infusion should be adapted to individual patient response 3
• Should not exceed the level of albumin found in normal individuals (about 2 g/kg body weight) in the absence of active bleeding 3

Burns

• Used after 24 hours post-burn injury 3
• Aim to maintain plasma albumin concentration at 2.5 ± 0.5 g/100 mL 3
• Duration determined by protein loss from burned areas and in urine 3

Hypoproteinemia With or Without Edema

• Usual daily dose: 50-75 g for adults and 25 g for children 3
• Administration rate should not exceed 2 mL/minute to avoid circulatory embarrassment and pulmonary edema 3
• Should be considered supportive rather than nutritional therapy 3

Other Indications

• Cardiopulmonary bypass: Used in pump prime to achieve hematocrit of 20% and plasma albumin concentration of 2.5 g/100 mL 3
• Acute liver failure: Supports colloid osmotic pressure and binds excess plasma bilirubin 3
• Neonatal hemolytic disease: 1 g/kg body weight given about 1 hour prior to exchange transfusion 3
• Sequestration of protein-rich fluids (acute peritonitis, pancreatitis, mediastinitis, extensive cellulitis) 3

Non-Recommended Uses

• Not recommended for patients with cirrhosis and extraperitoneal infections 1
• Not recommended for routine treatment of hypoalbuminemia in decompensated cirrhosis 1
• Not recommended for nutritional purposes 4

Administration Considerations

• Should always be administered intravenously 3
• May be given undiluted or diluted in 0.9% Sodium Chloride or 5% Dextrose in Water 3
• If sodium restriction is required, should only be administered undiluted or diluted in sodium-free carbohydrate solution 3
• For hypoproteinemic patients, rate should not exceed 2 mL/minute 3
• Parenteral products should be inspected visually for particulate matter and discoloration prior to administration 3

Cautions and Monitoring

• Monitor for signs of fluid overload, especially in patients with preexisting cardiac conditions 1
• Assess volume status, cardiovascular function, and kidney function before administration 1
• Consider personalized dosing based on baseline creatinine, volume of ascites removed, and history of hypotensive symptoms 1
• Be vigilant for pulmonary edema, especially when using higher doses for SBP 1