Albumin Infusion Time for 32 Grams in Large-Volume Paracentesis
For 32 grams of albumin (representing approximately 4 liters of ascites removed), the infusion should be administered slowly over several hours, typically 2-4 hours, to prevent circulatory overload, particularly in patients with underlying cardiac dysfunction. 1
Calculating the Volume Removed
- 32 grams of albumin at the standard dose of 8 g/L corresponds to approximately 4 liters of ascites removed 2, 1
- This falls below the 5-liter threshold where albumin becomes mandatory in standard-risk patients 2, 1
Timing and Administration Considerations
- The albumin infusion must be administered slowly to prevent cardiac overload, especially in patients with preexisting cardiomyopathy 1
- Albumin should be given during or immediately after the paracentesis procedure is completed 2, 1
- Using 20% or 25% albumin solution is recommended, which means 32 grams would be delivered in 128-160 mL of fluid 2
Critical Safety Monitoring
- Watch closely for signs of fluid overload and pulmonary edema during infusion, as these are recognized adverse effects of albumin administration 2, 3
- Monitor for hypotension/tachycardia, nausea/vomiting, rigors, pyrexia, and rash/pruritus during the infusion 2, 3
- Patients with cardiac dysfunction require particularly careful monitoring and potentially slower infusion rates 1
Special Circumstances for This Volume
- For paracentesis removing <5 liters (as in this case with ~4 L), albumin may not be routinely necessary in standard-risk patients 2, 1
- However, albumin at 6-8 g/L should still be considered if the patient has acute-on-chronic liver failure (ACLF) or high risk of post-paracentesis acute kidney injury 2, 1
- High-risk features include elevated baseline creatinine or blood urea nitrogen 3