Albumin from Egg Sources is NOT Recommended for Medical Correction of Hypoalbuminemia
The use of egg albumin (ovalbumin) for correction of hypoalbuminemia in clinical practice is not supported by any medical guidelines or evidence, and human serum albumin (HSA) infusions should be used only for specific evidence-based indications, not for nutritional correction of low albumin levels. 1, 2, 3
Critical Distinction: Dietary vs. Medical Albumin
Egg albumin (ovalbumin) is a dietary protein that cannot correct serum albumin levels in patients with liver disease, nephrotic syndrome, or malnutrition, as hypoalbuminemia in these conditions results from complex pathophysiological mechanisms beyond simple protein deficiency 1, 4
Serum albumin concentration reflects synthesis, breakdown, volume distribution, and losses—not dietary intake alone 1
Albumin is a negative acute phase reactant, meaning its synthesis decreases during acute illness regardless of nutritional intake 1
Evidence-Based Indications for Human Serum Albumin (NOT Egg Albumin)
Strong Recommendations (Moderate to High Quality Evidence)
Large-volume paracentesis (>5L): Administer 1.5 g/kg HSA to prevent paracentesis-induced circulatory dysfunction 2, 5, 3
Spontaneous bacterial peritonitis: Give 1.5 g/kg HSA at diagnosis and 1.0 g/kg on day 3, which reduces mortality and prevents hepatorenal syndrome 2, 5, 3
Sepsis-induced hypotension in cirrhosis: Use 5% HSA over normal saline, with demonstrated higher 1-week survival (43.5% vs 38.3%, p=0.03) 2, 6
Hepatorenal syndrome: Administer 20-40 g/day HSA combined with vasoconstrictors (albumin alone is ineffective) 6, 3
What NOT to Do
Do NOT use HSA for hypoalbuminemia correction alone in decompensated cirrhosis (adjusted OR 0.98,95% CI 0.71-1.33 for benefit) 2
Do NOT use HSA as first-line volume replacement in critically ill cirrhotic patients; balanced crystalloids (lactated Ringer's) are preferred for initial resuscitation 2, 6
Do NOT attempt nutritional correction with egg albumin or HSA infusions, as this approach is ineffective and not supported by evidence 1, 3, 7
Addressing Malnutrition in Kidney and Liver Disease
Low serum albumin associated with malnutrition requires treatment of the underlying disease, not albumin supplementation 1
Protein/calorie malnutrition may theoretically affect substrate availability for protein synthesis, but albumin infusions do not address this 1
Body composition assessment should be preferred over albumin levels when diagnosing malnutrition in hospitalized patients with kidney disease 1
Egg Allergy Considerations
Patients with egg allergy should avoid egg products entirely, but this is irrelevant to medical albumin therapy since egg albumin has no role in clinical correction of hypoalbuminemia 1, 3
Human serum albumin infusions do not contain egg proteins and can be safely administered to patients with egg allergies when medically indicated 3, 8
Safety Monitoring for HSA Infusions (When Indicated)
Monitor closely for volume overload, especially in patients with increased capillary permeability 2
Use echocardiography to guide fluid management and watch for respiratory distress or declining oxygen saturation 2, 6
Immediately discontinue if pulmonary edema develops, as the ATTIRE trial showed higher rates of pulmonary edema with albumin maintenance therapy 2, 6
Assess cardiac and pulmonary function before administration 2
Common Pitfalls to Avoid
Treating the albumin number instead of the patient: Hypoalbuminemia is a marker of illness severity, not a treatment target 1, 2, 7
Using albumin for nutritional purposes: This is ineffective and wastes resources 3, 7
Assuming dietary protein (including eggs) can correct medical hypoalbuminemia: The pathophysiology involves inflammation, synthesis impairment, and losses—not simple dietary deficiency 1, 4