From the Guidelines
Albumin should not be considered a fluid in the traditional sense, but rather a colloid solution used for volume expansion in clinical settings. According to the most recent and highest quality study, a 2024 guideline from the International Collaboration for Transfusion Medicine Guidelines published in Chest 1, albumin has been shown to be superior to other volume expanders for specific conditions, but its role and benefits vary depending on the clinical context.
Key Points
- Albumin is a blood product derived from human plasma that contains the protein albumin, which increases oncotic pressure within the bloodstream when administered intravenously, drawing fluid from the interstitial spaces into the vascular compartment.
- Unlike crystalloid fluids, albumin doesn't directly add significant volume to the circulation but works by redistributing existing body fluids, making it effective for treating conditions like hypovolemia, shock, burns, or hypoalbuminemia.
- The use of albumin has been evaluated in various clinical settings, including the prevention of postparacentesis circulatory dysfunction, spontaneous bacterial peritonitis, and hepatic encephalopathy, with mixed results.
- A 2021 systematic review identified that albumin may assist with the resolution or prevention of hepatic encephalopathy and may reduce mortality 1.
- However, albumin administration requires careful consideration of potential adverse effects, including allergic reactions, fluid overload, or pulmonary edema, especially in patients with cardiac or renal insufficiency.
- The 2024 guideline highlights the importance of weighing the benefits and risks of albumin use in different clinical contexts, considering factors such as the dose and duration of treatment, as well as the patient's underlying condition and comorbidities.
From the FDA Drug Label
If the patient is dehydrated, additional crystalloids must be given, (4) or alternatively, Albumin (Human) 5%, USP (Plasbumin®-5) should be used. Plasbumin-25 is hyperoncotic, therefore, in the presence of dehydration, albumin must be given with or followed by addition of fluids.
Albumin is not considered a fluid in the classical sense, but rather a colloid that can help maintain or expand plasma volume. However, it is often administered with or followed by the addition of fluids, such as crystalloids, to prevent dehydration or circulatory overload 2, 2.
- Key points:
- Albumin is a colloid with positive oncotic activity
- It can help maintain or expand plasma volume
- It should be administered with or followed by the addition of fluids in dehydrated patients
- It is not a substitute for crystalloids or other fluids, but rather a supplement to help maintain plasma volume and oncotic pressure.
From the Research
Definition of Albumin and Fluids
- Albumin is a type of protein found in blood plasma, which helps to regulate fluid balance and transport various substances throughout the body 3.
- Fluids, on the other hand, refer to any substance that flows freely and has no fixed shape, such as water, electrolyte solutions, or other intravenous fluids.
Relationship between Albumin and Fluids
- Albumin is often administered as an intravenous fluid to help expand plasma volume and improve blood pressure in patients with hypovolemia or shock 4, 5, 6.
- However, albumin itself is not considered a fluid in the classical sense, as it is a protein that is dissolved in the fluid portion of blood plasma 3.
Clinical Use of Albumin
- Albumin is commonly used to treat patients with spontaneous bacterial peritonitis (SBP), as it has been shown to reduce mortality and renal impairment in these patients 4, 5, 7, 6.
- The use of albumin in other clinical settings, such as intensive care units, is more controversial, and its effectiveness in reducing fluid requirements, infection rates, and mortality is still debated 3.