What is the recommended infusion rate for a 25% albumin solution in a patient with hypoalbuminemia?

Albumin Infusion Rate

For 25% albumin solution in hypoalbuminemia, the infusion rate should not exceed 2 mL per minute to prevent circulatory overload and pulmonary edema. 1

Standard Infusion Rates by Clinical Context

General Hypoalbuminemia

• Maximum rate: 2 mL/min for 25% albumin in hypoproteinemic patients with approximately normal blood volumes, as more rapid injection may precipitate circulatory embarrassment and pulmonary edema 1
• This translates to approximately 120 mL/hour maximum infusion rate 1

Large-Volume Paracentesis (Cirrhosis)

• Infuse albumin after paracentesis is completed at 8g albumin per liter of ascites removed using 20% or 25% solution 2, 3
• The infusion should occur over 1-4 hours post-procedure 2
• For a typical 10-liter paracentesis requiring 80g albumin (320 mL of 25% solution), this represents an infusion rate of approximately 80-320 mL/hour 2

Spontaneous Bacterial Peritonitis

• Standard dosing: 1.5 g/kg within 6 hours of diagnosis, followed by 1.0 g/kg on day 3 2, 3
• However, infusion over 6 hours is poorly tolerated in many patients, with 100% of patients in one trial developing symptomatic circulatory overload when standard doses were given over this timeframe 4
• The evidence suggests slower infusion rates over longer periods may be necessary, though specific optimal rates are not well-defined 4

Acute Ischemic Stroke (Investigational)

• In clinical trials, 25% albumin was administered over 2 hours at doses up to 2.05 g/kg 2
• This represents a significantly faster infusion rate than recommended for hypoalbuminemia, but was used in a specific research context with close monitoring 2

Critical Safety Considerations

Risk of Pulmonary Edema

• Pulmonary edema occurred in 13% of stroke patients receiving high-dose albumin over 2 hours, confirming the need for caution with rapid infusion 2
• In cirrhotic patients with sepsis-induced hypotension, 25% albumin increases risk of pulmonary complications despite better hemodynamic response 3
• Patients with normal or near-normal blood volumes are at highest risk when infusion rates exceed 2 mL/min 1

Monitoring During Infusion

• Watch for signs of circulatory overload: dyspnea, tachypnea, jugular venous distension, pulmonary crackles 1, 4
• Stop infusion immediately if respiratory distress develops 4
• In one study, when respiratory distress occurred, the infusion was stopped and not restarted for that dose 4

Practical Algorithm for Rate Selection

For 25% albumin in hypoalbuminemia:

1. Start at ≤2 mL/min (120 mL/hour) as the maximum safe rate 1

2. Consider slower rates (1 mL/min or 60 mL/hour) in patients with:

   • Severe hypoproteinemia with normal blood volume 1
   • History of heart failure or pulmonary disease 1
   • Cirrhosis with ascites 2, 4

3. For post-paracentesis administration:

   • Infuse over 1-4 hours after procedure completion 2
   • Calculate total volume needed (8g/L ascites × liters removed ÷ 0.25 = mL of 25% albumin) 2

4. For SBP treatment:

   • Consider extending infusion beyond 6 hours to reduce circulatory overload risk 4
   • Monitor closely for first 30-60 minutes of infusion 4

Common Pitfalls to Avoid

• Never infuse 25% albumin rapidly in patients with normal blood volume - this is the highest risk scenario for pulmonary edema 1
• Do not use the 2-hour infusion rate from stroke trials (designed for research settings with intensive monitoring) in routine clinical practice for hypoalbuminemia 2
• Avoid 5% albumin when sodium restriction is important - it increases sodium load five-fold compared to 25% solution 3
• Do not continue infusion if respiratory distress develops - stop immediately and reassess volume status 4