Albumin Infusion Rate
Albumin should be infused after paracentesis is completed, with the infusion rate not exceeding 2 mL per minute in hypoproteinemic patients to prevent circulatory embarrassment and pulmonary edema. 1
Standard Infusion Rates by Clinical Context
For Large Volume Paracentesis (>5L)
- Administer albumin after the paracentesis procedure is complete, not during the drainage 2, 3, 4
- The paracentesis itself should be completed rapidly over 1-4 hours, draining to dryness in a single session 4
- Following drainage, infuse 20% or 25% albumin at the calculated dose (8 g per liter of ascites removed) 2, 3
- Maximum infusion rate: 2 mL per minute to avoid circulatory overload, particularly in patients with hypoproteinemia who typically have normal blood volumes 1
For Spontaneous Bacterial Peritonitis (SBP)
- Standard dosing: 1.5 g/kg within 6 hours of diagnosis, followed by 1 g/kg on day 3 2, 5
- Critical safety consideration: The standard 6-hour infusion protocol causes symptomatic circulatory overload in the majority of patients 6
- A 2023 randomized trial found that 100% of patients receiving standard-dose albumin infused over 6 hours developed symptomatic circulatory overload requiring premature discontinuation 6
- Consider slower infusion rates over more prolonged periods (beyond 6 hours) to improve tolerability, though optimal duration requires further study 6
For Septic Shock in Cirrhosis
- 20% albumin at 0.5-1.0 g/kg can be infused over 3 hours for hemodynamic resuscitation 7
- This achieves faster improvement in mean arterial pressure compared to crystalloids 7
- Close monitoring is essential as 22% of patients required discontinuation due to pulmonary complications with this rapid infusion 7
Practical Infusion Calculations
Using 25% Albumin Solution
- 25% albumin contains 25 g of albumin per 100 mL 3
- For 8 L paracentesis requiring 64 g albumin: infuse 256 mL of 25% albumin 2
- At maximum rate of 2 mL/min: this would take approximately 128 minutes (just over 2 hours) 1
Using 20% Albumin Solution
- 20% albumin contains 20 g per 100 mL 2, 3
- For 8 L paracentesis requiring 64 g albumin: infuse 320 mL of 20% albumin 2
- At maximum rate of 2 mL/min: this would take approximately 160 minutes (2.7 hours) 1
Critical Safety Warnings
Rapid infusion poses significant risks:
- Circulatory overload and pulmonary edema are the primary concerns, especially in patients with normal or expanded blood volumes 1, 6, 7
- 20% albumin is hyperoncotic and draws additional fluid from interstitial spaces, expanding plasma volume by 3-4 times the infused volume 1
- Monitor closely for respiratory distress during infusion and stop immediately if it develops 6
Special populations requiring slower rates:
- Patients with severe hypoproteinemia and normal blood volumes 1
- Patients with cardiac dysfunction or risk of volume overload 6
- Patients receiving large albumin doses for SBP (>87.5 g total may worsen outcomes due to fluid overload) 2
Timing Considerations
- For paracentesis: Always infuse after the procedure is completed, not during drainage 2, 3, 4
- For SBP: Begin within 6 hours of diagnosis for the first dose 2, 5
- The second SBP dose should be given on day 3 2
- For burn patients: Infusion timing depends on the phase of injury (typically beyond 24 hours post-burn) 1