Infusion Time for 100 mL of 20% Albumin
100 mL of 20% albumin should typically be infused over 7-30 minutes based on clinical context, with faster administration (median 7 minutes) commonly used in post-cardiac surgery patients and slower infusion (30 minutes) used in controlled research settings.
Evidence-Based Infusion Rates
Rapid Infusion Protocol
- Post-cardiac surgery patients received 100 mL of 20% albumin with a median infusion duration of 7 minutes (IQR 3-9 minutes), demonstrating that rapid administration is feasible and commonly practiced in acute care settings 1
- Faster fluid bolus administration predicted greater MAP increase at the end of the bolus in post-surgical patients 1
Standard Infusion Protocol
- In controlled research settings, 3 mL/kg of 20% albumin (approximately 200-250 mL for average adults) was administered over 30 minutes, suggesting an infusion rate of approximately 15-20 minutes for 100 mL when following this protocol 2, 3, 4
- This slower rate was used consistently across multiple pharmacokinetic studies in both surgical patients and volunteers 2, 3, 4
Context-Specific Considerations
Cirrhosis Patients
- For spontaneous bacterial peritonitis, albumin should be given within 6 hours of diagnosis (1.5 g/kg), but specific infusion duration is not mandated by guidelines 5
- After large-volume paracentesis, albumin is infused after the procedure is completed at 8 g/L of ascites removed, though exact infusion time is not specified 5
- One retrospective study suggested doses exceeding 87.5 g (>4×100 mL of 20% albumin) may be associated with worse outcomes due to fluid overload, emphasizing the importance of monitoring during administration 5
Critical Care Settings
- In ongoing trials for septic shock and acute kidney injury, 100 mL doses of 20% or 25% albumin are being studied, though specific infusion times are not detailed in the trial protocols 5
- For cardiac surgery patients, one trial protocol specified that 20% albumin would be "administered on arrival in the ICU and continued for 15 hours," suggesting prolonged infusion for larger volumes 5
Important Safety Considerations
Risk of Fluid Overload
- Fluid overload is a documented complication of albumin administration in cirrhotic patients, particularly with higher doses or rapid administration 5
- Patients with increased or rising serum creatinine require careful monitoring during albumin infusion 5
Hemodynamic Response Patterns
- MAP response to 20% albumin is maximal during the bolus but dissipates rapidly (median 6-7 minutes) in post-cardiac surgery patients, while cardiac index response may develop more gradually over 30 minutes 1
- This dissociation between MAP and cardiac index responses suggests that clinical assessment should extend beyond the immediate infusion period 1
Practical Algorithm
For acute resuscitation (hypotension, post-cardiac surgery):
- Infuse 100 mL over 5-10 minutes
- Monitor blood pressure continuously during and for 15 minutes after infusion 1
For cirrhosis-related indications (SBP, post-paracentesis):
- Infuse 100 mL over 15-30 minutes
- Monitor for signs of fluid overload (dyspnea, peripheral edema) 5
- Avoid exceeding 400 mL (87.5 g) in patients at risk for volume overload 5
For elective volume expansion: