Does IV Albumin Worsen Hypothermia in Hyponatremic Patients?
No, there is no evidence that administering IV albumin to patients with hyponatremia aggravates hypothermia. The available guidelines and research do not identify hypothermia as a complication or adverse effect of albumin administration in hyponatremic patients.
Evidence Review
The comprehensive 2024 guidelines on albumin use from the International Collaboration for Transfusion Medicine Guidelines extensively reviewed albumin's safety profile across multiple clinical scenarios, including critical care, cirrhosis, and various fluid resuscitation contexts 1. Notably absent from these guidelines is any mention of hypothermia as a complication of albumin administration.
Documented Adverse Effects of Albumin
The actual adverse effects associated with albumin administration include 1:
- Fluid overload and pulmonary edema (particularly when used inappropriately in hypervolemic states)
- Hypotension
- Hemodilution requiring RBC transfusion
- Anaphylaxis (rare)
- Peripheral gangrene from dilution of natural anticoagulants (rare)
Albumin's Role in Hyponatremia Management
For patients with cirrhosis and hyponatremia, albumin infusion is actually recommended as part of the treatment strategy 1, 2. The 2024 AGA guidelines specifically recommend albumin for:
- Large-volume paracentesis (>5L) to prevent circulatory dysfunction 1
- Spontaneous bacterial peritonitis with AKI and/or jaundice 1
- Hypervolemic hyponatremia in cirrhosis alongside fluid restriction 2, 3
Research demonstrates that hospitalized cirrhotic patients with hyponatremia who received IV albumin had higher rates of hyponatremia resolution (69% vs 61%, p=0.008) compared to those who did not receive albumin 3. This resolution was independent of renal function and baseline sodium levels 3.
Clinical Context
The concern about hypothermia appears to be a misconception. Albumin solutions are typically stored at room temperature and administered at or near body temperature, making them unlikely to cause hypothermia. In contrast, rapid infusion of large volumes of cold crystalloid solutions could theoretically contribute to hypothermia, but this is a function of infusion temperature and volume, not the specific fluid type.
Important Caveats
While albumin does not cause hypothermia, clinicians should be aware of:
- Pulmonary edema risk: The ATTIRE trial found higher rates of pulmonary edema in cirrhotic patients receiving albumin (10 times the amount of control group) 1
- Volume overload: In hypervolemic hyponatremia, albumin should be used cautiously alongside fluid restriction 2
- Correction rate monitoring: When treating hyponatremia with any intervention including albumin, sodium correction must not exceed 8 mmol/L in 24 hours to prevent osmotic demyelination syndrome 2