Human Albumin
Indications
Human Albumin is used for:
Acute hypovolaemic shock, Hypoproteinaemia
Adult Dose
Intravenous
Acute hypovolaemic shock
Adult: Initially, 25 g of albumin, adjusted according to patient's response. may repeat q15-30min if response inadequate
Not to exceed 250 g/48 hr
Hypoproteinaemia
Adult: Up to 2 g/kg daily.
Choice of 5% vs 20%/25% depends on whether patient requires primarily volume (5%) or primarily protein/oncotic pressure (20%/25%)
Child Dose
Intravenous
Acute hypovolaemic shock
Child: Up to 1 g/kg, adjusted according to patient's response.
Neonatal hyperbilirubinaemia
Child: 1 g/kg of albumin before exchange transfusion.
Neonates (<28 days old)/infants: 10-20 mL/kg IV of 5% solution
500-1000 mg/kg IV infusion
Not to exceed 250 g/48 hr or 6 g/kg/day
Renal Dose
Administration
IV Administration
Do not dilute 5% solution
Albumin 20%/25% may be given undiluted or diluted in NS
Hypoproteinemia:
Infuse over 30-120 min; not to exceed 5-10 mL/min for 5% solution, 2 mL/min for 20% solution, and 2-3 mL/min for 25% solution
Hypovolemic shock
Initial bolus infusion as rapidly as desired
As plasma volume approaches normal, infuse 5% solution up to 2-4 mL/min and 25% solution up to 1 mL/min to avoid circulatory overload
Contra Indications
Cardiac failure, severe anaemia, history of hypersensitivity, parenteral nutrition.
Precautions
Hypertension or low cardiac reserve; additional fluids for dehydrated patients. Monitor for signs of cardiac overload in injured or postoperative patients. May carry risk of viral transmission. Volume admin and rate of infusion must always be individualised according to situation and response. Pregnancy, lactation.
Lactation: Endogenous albumin found in breast milk; compatible
Pregnancy-Lactation
Interactions
Albumin solution should not be mixed by protein hydrolysates or alcoholic solutions. Risk of atypical reactions to ACE inhibitors in patients undergoing therapeutic plasma exchange with albumin human replacement.
Adverse Effects
Side effects of Human Albumin :
Allergic reactions, nausea, vomiting, increased salivation, fever and chills; vascular overload, haemodilution and pulmonary oedema.
Potentially Fatal: Anaphylactic shock.
Mechanism of Action
Human albumin increases intravascular oncotic pressure and causes movement of fluids from interstitial into intravascular space. Human albumin solutions are available in various concentrations. Solutions containing 5% human albumin are usually used in hypovolemic patients, whereas more concentrated 25% solutions are recommended in patients in whom fluid and sodium intake must be minimised e.g. patients with hypoproteinaemia or cerebral oedema or in paediatric patients.