What is the proper procedure for administering an albumin infusion?

How to Administer Albumin Infusion

Preparation and Solution Selection

Use 20% or 25% albumin solution for most clinical indications to minimize infusion volume, particularly in patients with cirrhosis or fluid-sensitive conditions. 1, 2

• Both 5% and 25% albumin solutions are isotonic and safe for intravenous administration 3
• Never dilute 25% albumin with sterile water alone, as this creates a hypotonic solution that causes fatal hemolysis 4
• If dilution is necessary, use only 0.9% NaCl or 5% dextrose (when sodium load is a concern) 4
• The 5% solution increases sodium load five-fold compared to 25% solution 3

Administration Technique

Infusion Rate and Timing

• Administer albumin intravenously over 30 minutes for standard dosing 5
• For large-volume paracentesis, infuse albumin after completion of the paracentesis procedure 2
• For spontaneous bacterial peritonitis, give the first dose within 6 hours of diagnosis 2, 6

Vascular Access

• Use standard peripheral or central intravenous access
• The 25% solution has higher viscosity but is still easily infused through standard IV lines 7

Indication-Specific Dosing Protocols

Large-Volume Paracentesis (>5 Liters)

• Administer 8g albumin per liter of ascites removed using 20% or 25% solution 2, 6
• For 25g albumin dose: use 100 mL of 25% solution or 125 mL of 20% solution 1
• This prevents post-paracentesis circulatory dysfunction and renal impairment 6
• Albumin replacement is generally not required for paracentesis <5L 6

Spontaneous Bacterial Peritonitis

• First dose: 1.5g/kg within 6 hours of diagnosis 2, 6
• Second dose: 1g/kg on day 3 2, 6
• Base dosing on estimated dry weight 2
• This regimen reduces renal dysfunction risk by 72% and mortality by 47% 6

Hepatorenal Syndrome

• Use albumin in combination with vasoconstrictors such as terlipressin 2
• Specific dosing varies by protocol but typically follows paracentesis guidelines 2

Sepsis-Induced Hypotension in Cirrhosis

• Use 5% albumin as fluid resuscitation 2
• Monitor closely for pulmonary complications if using 25% albumin 2

Intradialytic Hypotension

• Use 25% albumin in patients with serum albumin <30 g/L 2
• Improves hypotension, lowest systolic BP, and ultrafiltration rate 2

Expected Physiologic Response

• 100 mL of 25% albumin (25g) increases serum albumin by approximately 0.2-0.3 g/dL 1
• 20% albumin produces plasma volume expansion equal to twice the infused volume 5
• Peak effect occurs shortly after infusion, with 40-60% remaining in circulation initially 1
• By 6 hours, 42-47% of administered albumin has leaked into interstitial space 5
• Albumin infusions increase albumin degradation rates significantly—58% of infused albumin is degraded, with a 15% increase in serum albumin leading to 39% increase in degradation 3, 1

Critical Safety Considerations

Monitoring During Infusion

• Watch for signs of fluid overload, particularly in patients with compromised cardiac function 2
• Monitor for anaphylaxis, though rare 2
• Assess for hypotension during administration 2

Contraindications and Cautions

• Do not use albumin for hypoalbuminemia alone—serum albumin concentration does not reflect albumin function in liver disease 2
• Avoid routine use in critically ill patients without specific indications, as it offers no survival benefit over crystalloids 2
• Use 25% albumin with extreme caution in patients with fluid overload and hypoproteinemia due to pulmonary edema risk 2

Common Pitfalls to Avoid

• Never use albumin for nutritional purposes or to correct low albumin levels without a specific indication 8
• Do not use albumin for routine volume replacement in surgery or critical care 2
• Avoid administering albumin before paracentesis—wait until the procedure is complete 2
• Do not assume all hypoalbuminemic patients need albumin—this is not evidence-based 2, 8