From the Guidelines
Albumin is primarily indicated for the treatment of hypovolemia, hypoalbuminemia, and certain specific clinical conditions, such as cirrhosis with ascites, nephrotic syndrome, or protein-losing enteropathy, as supported by the most recent guidelines from the international collaboration for transfusion medicine guidelines 1. The use of albumin in these conditions is based on its ability to increase oncotic pressure, maintain intravascular volume, and bind/transport various substances in the blood.
- In liver disease, albumin is recommended for:
- Albumin may also be used in acute respiratory distress syndrome, severe sepsis with hypotension unresponsive to crystalloids, and during plasmapheresis, as suggested by recent studies 1. However, it should be used cautiously in patients with heart failure, pulmonary edema, or severe anemia, and is generally not recommended as a first-line fluid for routine volume replacement when crystalloids would suffice 1. The typical dosage ranges from 0.5-1.5 g/kg depending on the indication, administered as a 5% or 25% solution, and should be individualized based on the patient's specific needs and clinical condition 1.
From the FDA Drug Label
INDICATIONS AND USAGE Emergency Treatment of Hypovolemic Shock Plasbumin-25 is hyperoncotic and on intravenous infusion will expand the plasma volume by an additional amount, three to four times the volume actually administered, by withdrawing fluid from the interstitial spaces, provided the patient is normally hydrated interstitially or there is interstitial edema. Removal of ascitic fluid from a patient with cirrhosis may cause changes in cardiovascular function and even result in hypovolemic shock. Burn Therapy Hypoproteinemia With or Without Edema Adult Respiratory Distress Syndrome (ARDS) Cardiopulmonary Bypass Acute Liver Failure Neonatal Hemolytic Disease Sequestration of Protein Rich Fluids Erythrocyte Resuspension Acute Nephrosis Renal Dialysis
The indications for albumin are:
- Emergency Treatment of Hypovolemic Shock
- Burn Therapy
- Hypoproteinemia With or Without Edema
- Adult Respiratory Distress Syndrome (ARDS)
- Cardiopulmonary Bypass
- Acute Liver Failure
- Neonatal Hemolytic Disease
- Sequestration of Protein Rich Fluids
- Erythrocyte Resuspension
- Acute Nephrosis
- Renal Dialysis 2 2
From the Research
Indications for Albumin
The indications for albumin administration can be summarized as follows:
- Fluid replacement in plasmapheresis and liver diseases, including hepatorenal syndrome, spontaneous bacterial peritonitis, and large-volume paracentesis, have a moderate to high quality of evidence and a strong recommendation for administering albumin 3, 4, 5.
- Albumin is used as a second-line and adjunctive to crystalloids for fluid resuscitation in hypovolemic shock, sepsis and septic shock, severe burns, toxic epidermal necrolysis, intradialytic hypotension, ovarian hyperstimulation syndrome, major surgery, non-traumatic brain injury, extracorporeal membrane oxygenation, acute respiratory distress syndrome, and severe and refractory edema with hypoalbuminemia has a low to moderate quality of evidence and weak recommendation to use 3.
- Albumin administration is most indicated in management of cirrhosis complications, such as hepatorenal syndrome, spontaneous bacterial peritonitis, and large-volume paracentesis 4, 5, 6.
- Fluid resuscitation or treatment of severe and refractory edema, especially in patients with hypoalbuminemia and not responding to other treatments, is another rational use for albumin 3, 7.
Specific Clinical Scenarios
Some specific clinical scenarios where albumin may be indicated include:
- Cirrhosis and spontaneous bacterial peritonitis 4, 5, 6
- Cirrhosis undergoing large volume paracentesis 4, 5
- Type 1 hepatorenal syndrome 4, 5
- Sepsis and septic shock 3, 7
- Therapeutic plasmapheresis with exchange of large volumes of plasma 3, 4
- Burns, nephrotic syndrome, hemorrhagic shock, and prevention of hepatorenal syndrome, although these are not first-choice treatments and are not supported by widely accepted guidelines 4, 5