From the Guidelines
Total parenteral nutrition (TPN) does not typically require albumin supplementation for most patients, as evidenced by the most recent and highest quality study 1. Albumin levels may decrease during TPN therapy due to several factors including dilution from fluid administration, redistribution, and altered synthesis, but routine albumin supplementation is not recommended. Some key points to consider when evaluating the need for albumin supplementation in patients receiving TPN include:
- Albumin should only be considered in specific clinical scenarios such as severe hypoalbuminemia (less than 2 g/dL) with associated clinical manifestations like edema, poor wound healing, or in patients with significant third-spacing of fluids that is not responding to other interventions.
- When albumin is deemed necessary, typical dosing is 25g (100mL of 25% solution) administered intravenously, which may be repeated based on clinical response and albumin levels.
- The underlying cause of hypoalbuminemia should be addressed simultaneously, as albumin replacement alone is a temporary measure.
- TPN itself should provide adequate protein substrate (typically 1.2-2 g/kg/day) to support albumin synthesis in patients with normal liver function, as supported by earlier studies 1.
- Monitoring of albumin levels during TPN therapy is important, but interpretation should consider the overall clinical context rather than treating the number alone, as highlighted in more recent research 1 and guidelines 1. It is essential to prioritize the patient's overall clinical context and address the underlying cause of hypoalbuminemia, rather than relying solely on albumin supplementation, in order to optimize morbidity, mortality, and quality of life outcomes.
From the Research
TPN and Albumin
- Total Parenteral Nutrition (TPN) is a method of providing nutrients to patients who are unable to consume them through the gastrointestinal tract 2.
- TPN can be used to support patients with various conditions, including cancer, and can help to promote wound healing and sustain nutritional requirements 2, 3.
- However, TPN may not be effective in reversing hypoalbuminemia, a condition characterized by low levels of albumin in the blood, in patients with cancer 3.
- Albumin supplementation during TPN has been shown to reduce hospital morbidity in hypoalbuminemic patients, suggesting that albumin plays an important role in maintaining patient health 4.
- Hypoalbuminemia is associated with inflammation and can be caused by various factors, including increased capillary permeability and escape of serum albumin, leading to expansion of interstitial space and increasing the distribution volume of albumin 5.
- Management of hypoalbuminemia should be based on correcting the causes of ongoing inflammation rather than infusion of albumin, and nutrition support can help to slow down the decline in muscle mass and function associated with aging and comorbidity 5.
- Both TPN and partial parenteral nutrition (PPN) can be used safely in chronic ICU patients to provide nutritional support and prevent catabolic state, but precise selection criteria are needed to choose the patients who would benefit the most from these methods 6.