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Dr. Ajith Kumar J MD
Dept. of Emergency Medicne
Travancore Medicity, Kollam
India
editor
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.
SAFE STUDY (Saline v/s Albumin Evaluation)
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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
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emmedonline
Dr. Ajith Kumar J MD
Dept. of Emergency Medicne
Travancore Medicity, Kollam
India
editor