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• Human albumin consists of a single polypeptide chain of 585 aminoacids with a molecular weight of 66,500 Da.

• Human albumin accounts for 55% of total serum protein. Albumin is specifically synthesized by hepatocytes.

• Albumin is synthesized at a rate of 12 -25g/day, accounting for 50% of energy consumption of hepatocytes.

• It is the principal transport protein in blood and is responsible for 75% of the colloid osmotic pressure in plasma. It also has an antioxidant activity.

• Transport of lower molecular substance like bilirubin, hormone, certain drugs.

• Hypoalbuminemia is a prognostic indicator, albumin therapy has shown to reduce complication rates when serum albumin levels are higher than 30g/l.

• They are available as 5% or 25% solution in an isotonic saline diluent. 5% albumin has colloid osmotic pressure of 20mmHg equal to plasma. The effect lasts for about 12-18 hrs.

• Infusion of 25% solution is not recommended as it is non physiological . They merely cause the shift of the fluid from one fluid compartment to another. It should not be used as a volume replacement therapy for patients with acute blood loss or dehydration.

Indication

• Role of albumin in sepsis:

   

  • Albumin decreases inhibition of endothelial activation, decreased edema formation through inhibiting sepsis induced capillary permeability and preservation of normal blood rheology.

     

  • Albumin also leads to increased plasma thiol levels which are sustained after albumin is cleared from circulation. This initiates a cascade of thiol oxidative reductive reaction and influence cellular signaling process.

  • Despite increase in vascular permeability in sepsis, administration of albumin in septic patients will lead to expansion of plasma volume.

  • Surviving Sepsis campaign recommends albumin as the fluid of choice when large amounts of crystalloid is required.

     

• Plasma volume expansion : Burns, Ovarain Hyperstimulation syndrome

   

• Correction of hypoproteinemia: In liver disease, diuretic resistant nephrotic syndrome, hypoalbuminemia related hypotension in hemodialysis patients or malnutrition

   

• Plasmapheresis : It is used as an exchange fluid to replace removed plasma.

   

• Albumin is also used for volume expansion in CABG surgery, pump priming fluid.

Adverse effect

• Anaphylatic shock

• Febrile reaction

• Nausea, vomiting

Precaution and contraindication

• Rapid infusion can lead to fluid overload and pulmonary edema.

• Contraindicated in severe anemia or cardiac failure.

How to give ?

• 500 ml of 5% solution @ 1-2ml/min.

Updated on 20/1/2015

Reference

• Practical Guidelines on Fluid Therapy. By Dr. Sanjay Panday

• Resuscitation Fluids. John A Myburgh. Critical Care Medicine, Review Article. NEJM. 2013

• Annual update in intensive care and emergency medicine . 2014 By. J.L. Vincent