20% Albumin Infusion Rate in Clinical Practice
Direct Answer
For 20% albumin administration, infuse at a rate of ≤2 mL/min (approximately 120 mL/hour) in euvolemic patients to prevent fluid overload, with slower rates required in high-risk populations. 1
Standard Infusion Rate Parameters
The maximum safe infusion rate is 2 mL/min (120 mL/hour) for 25% albumin in euvolemic patients, which should be applied to 20% albumin as well to prevent circulatory overload 1
For a typical 100 mL vial of 20% albumin, this translates to approximately 50 minutes minimum infusion time when using the standard rate
Research demonstrates that 20% albumin administered over 30 minutes (approximately 6-7 mL/min for 200 mL) expands plasma volume by 1.7 times the infused volume, but this rapid rate should be reserved for research protocols only 2, 3
Context-Specific Dosing and Rates
Large-Volume Paracentesis
- Administer 8 g albumin per liter of ascites removed after the procedure is completed 4, 5, 1
- Infuse slowly to prevent cardiac overload, particularly when total doses approach or exceed 87.5 g (>350 mL of 20% albumin) 4, 1
Spontaneous Bacterial Peritonitis
- First dose: 1.5 g/kg within 6 hours of diagnosis 4, 5, 1
- Second dose: 1.0 g/kg on day 3 4, 5, 1
- For a 70 kg patient, this equals approximately 525 mL of 20% albumin for the first dose—infuse over 4-5 hours minimum to maintain the ≤2 mL/min safety threshold
Hepatorenal Syndrome
- Initial dose: 1 g/kg before starting vasoconstrictor therapy 5
- Maintenance: 20-40 g/day during vasoconstrictor treatment 5
High-Risk Scenarios Requiring Slower Infusion
Mandatory slower infusion rates (≤1 mL/min or 60 mL/hour) are required when: 1
- Total dose exceeds 87.5 g (>350 mL of 20% albumin) 4, 1
- Patient has elevated or rising serum creatinine 4, 1
- Cirrhotic patients with preexisting cardiomyopathy 1
- Any patient with existing fluid overload 4
Critical Monitoring During Infusion
Mandatory monitoring parameters include: 1
- Circulatory overload signs: jugular venous distension, pulmonary crackles, worsening dyspnea
- Hypotension: paradoxical hypotension can occur
- Hemodilution: may require RBC transfusion if severe
- Anaphylaxis: rare but documented
- Peripheral gangrene: from dilution of natural anticoagulants
Pharmacokinetic Considerations
20% albumin expands plasma volume by approximately 1.7-2.0 times the infused volume 2, 3, 6
The intravascular half-life of albumin molecules is 6-20 hours, with longer persistence in postoperative patients (median 9.1 hours) compared to volunteers (median 6.0 hours) 6
The plasma volume expansion half-life is 7.6-21.7 hours, meaning the effect is transient and not suitable for chronic hypoalbuminemia correction 2, 6
Rapid infusion (30 minutes) results in greater area under the plasma volume curve compared to slow infusion (180 minutes), but this does not translate to better clinical outcomes and increases fluid overload risk 7
When NOT to Use 20% Albumin
The 2024 International Collaboration for Transfusion Medicine Guidelines explicitly recommend against albumin use for: 8, 4
- Correcting hypoalbuminemia alone without specific complications
- First-line volume replacement in critically ill adults (excluding burns/ARDS)
- Routine use in cardiovascular surgery
- Intradialytic hypotension as routine therapy
- Uncomplicated ascites in cirrhosis
- Extraperitoneal infections in cirrhosis
Common Pitfalls to Avoid
Never use albumin for chronic daily administration in fluid overload with hypoalbuminemia—this worsens fluid overload rather than improving it 4
Avoid doses exceeding 87.5 g in cirrhotic patients due to association with worse outcomes from fluid overload 4
Do not infuse faster than 2 mL/min in standard situations—rapid infusion increases risk of circulatory overload without improving efficacy 1, 7
Recognize that albumin costs approximately $130 per 25 g, making inappropriate use both clinically harmful and economically wasteful 5, 1