What is the maximum rate at which albumin (human albumin) infusion can be administered?

Maximum Rate of Albumin Infusion Administration

The maximum rate at which human albumin infusion can be administered is 2 mL per minute for concentrated albumin solutions (20-25%) to avoid circulatory embarrassment and pulmonary edema. 1

General Administration Guidelines

• Albumin should always be administered intravenously, either undiluted or diluted in 0.9% Sodium Chloride or 5% Dextrose in Water 1
• If sodium restriction is required, albumin should only be administered either undiluted or diluted in a sodium-free carbohydrate solution such as 5% Dextrose in Water 1
• The rate of administration should be adjusted based on the patient's clinical condition and the concentration of albumin being used 1

Specific Administration Rates by Clinical Scenario

Hypoproteinemia

• For patients with hypoproteinemia, the rate of administration should not exceed 2 mL per minute, as more rapid injection may precipitate circulatory embarrassment and pulmonary edema 1
• The usual daily dose of albumin for adults with hypoproteinemia is 50 to 75 g and for children 25 g 1

Burns

• For burn patients (usually beyond 24 hours post-injury), albumin doses are generally around 1-2 g/kg/day to maintain albumin levels at >30 g/L 2
• This helps decrease the infused volumes of crystalloid and the resulting morbidity 2

Congenital Nephrotic Syndrome

• In children with congenital nephrotic syndrome requiring regular albumin infusions, doses of up to 1-4 g/kg may be administered daily 2
• The frequency and dosage should be based on clinical indicators of hypovolemia rather than on serum albumin levels 2

Cirrhosis with Ascites

• For large volume paracentesis, albumin should be administered at a dose of 6-8 g for every liter of ascites removed 2
• For example, after removing 5 liters, approximately 40 g of albumin should be infused, and after 8 L removal, approximately 64 g should be given 2

Factors Affecting Plasma Volume Expansion

• The plasma volume expansion effect depends on the amount of albumin given and the deficit in plasma volume, not on the concentration of the solution 3
• One injection of 100 mL of 25% albumin solution typically increases serum albumin levels by approximately 0.2-0.3 g/dL 4
• When administered intravenously, approximately 40-60% of albumin remains in the circulation initially 4

Cautions and Contraindications

• More rapid infusion rates may lead to:
  • Circulatory overload 1
  • Pulmonary edema 1
  • Hemodynamic disturbances 2
• The rate should be reduced in patients with cardiac or pulmonary insufficiency 1
• Slower infusion rates may be more efficient for plasma volume expansion in certain clinical scenarios such as sepsis 5

Common Pitfalls to Avoid

• Administering albumin too rapidly can cause fluid overload, especially in patients with cardiac or renal insufficiency 1
• Using albumin as a source of nutrition is not appropriate - oral or parenteral feeding with amino acids should be initiated for long-term protein supplementation 1
• Ignoring the patient's volume status before albumin administration can lead to complications - assessment of intravascular volume is essential 2
• Failing to monitor for signs of pulmonary edema during albumin administration, especially with rapid infusion rates 1

Remember that the infusion rate should be adjusted based on the patient's clinical condition, with careful monitoring of vital signs, urine output, and signs of fluid overload during administration.