Dilution of 20% Albumin to 5% Albumin
To prepare 5% albumin from 20% albumin, mix 1 part 20% albumin with 3 parts sterile diluent (either 0.9% sodium chloride or 5% dextrose in water) using strict sterile technique. 1
Critical Safety Warning
- Never use sterile water alone as a diluent for albumin—this creates a hypotonic solution that causes severe hemolysis and can be fatal. 1, 2
- Between 1994-1998, at least 10 episodes of hemolysis (including one death) occurred in the United States when 25% albumin was inappropriately diluted with sterile water alone. 2
Step-by-Step Dilution Protocol
Acceptable Diluents
- Use only 0.9% sodium chloride (normal saline) or 5% dextrose in water as diluents for albumin. 1
- Choose 5% dextrose when sodium restriction is clinically important, as 5% albumin delivers approximately five-fold more sodium than 25% albumin. 3
Calculation Method
- Apply the formula C₁V₁ = C₂V₂ where C₁ = initial concentration (20%), V₁ = volume of 20% albumin needed, C₂ = target concentration (5%), and V₂ = final volume desired. 4
- For every 100 mL of final 5% albumin solution: mix 25 mL of 20% albumin with 75 mL of sterile diluent (0.9% NaCl or 5% dextrose). 4
- Example: To prepare 400 mL of 5% albumin, combine 100 mL of 20% albumin with 300 mL of appropriate diluent.
Sterile Technique Requirements
- Use sterile syringes and maintain aseptic technique throughout the preparation process to prevent microbial contamination. 4
- Prepare the solution immediately before use for optimal safety and efficacy. 4
- Do not use vials that are cracked, previously entered, or damaged, as microorganisms may have entered. 1
Administration Guidelines
Timing and Storage
- Do not begin administration more than 4 hours after the container has been entered. 1
- Discard partially used vials—albumin contains no preservative and cannot be stored after opening. 1
- Label the prepared solution clearly with medication name, concentration (5% albumin), date and time of preparation, and expiration time. 4
Quality Control Checks
- Do not use if the solution is turbid or has been frozen. 1
- The solution should be clear, slightly viscous, and colorless to yellow, amber, or green. 1
Common Pitfalls to Avoid
- Never dilute with sterile water alone—this is the most critical error and has caused fatal hemolysis. 1, 2
- Do not prepare large batches in advance, as albumin lacks preservatives and must be used within 4 hours of container entry. 1
- Do not confuse dilution ratios: 20% to 5% requires a 1:3 ratio (1 part albumin to 3 parts diluent), not a 1:4 ratio. 4
- Avoid using solutions that have been stored improperly or show any signs of contamination or turbidity. 1
Clinical Context
While this dilution method is technically feasible, current guidelines recommend against routine albumin use in most clinical settings and specifically advise against routine use in critically ill patients for volume replacement. 5, 3 The primary evidence-based indications for albumin are limited to specific liver disease complications (large-volume paracentesis >5L, spontaneous bacterial peritonitis, hepatorenal syndrome) and fluid replacement during plasmapheresis. 5, 6, 3, 7