Dilution: If concentrated albumin solutions are to be diluted before use, a suitable solution such as sodium chloride 0.9% or glucose 5% must be used. Albumin 25% that was erroneously diluted with water to produce a hypo-osmolar albumin 5% solution has produced severe haemolysis and renal failure in patients undergoing plasmapheresis, 1,2 including a fatality in one patient.
Uses and Administration: Albumin is the major protein involved in maintaining colloid osmotic pressure in the blood. II also binds a number of endogenous and exogenous substances including bilirubin, steroid hormones, and many, mainly acidic, drugs. Albumin solutions are used for plasma volume replacement and to restore colloid osmotic pressure.
They have been used in conditions such as burns, severe acute albumin loss, and acute hypovolaemic shock. They are also used as an exchange fluid in therapeutic plasmapheresis. Concentrated albumin solutions are used in neonatal hyperbilirubinaemia associated with haemolytic disease of the newborn.
They have also been suggested for short-term management of hypoproteinaemia in hepatic disease and in diuretic-resistant patients with nephrotic syndrome but are of little value in chronic hypoproteinaemias. Albumin may be included in diagnostic preparations such as those labelled with technetium-99m for use as radiopharmaceuticals in scanning of the heart, lung, liver, spleen, bone marrow, veins, and lymphatic system. Albumin labelled with iodine-125 is used to measure blood and plasma volumes, blood circulation, and cardiac output. A suspension of albumin microspheres with perflutren is available for enhancing cardiac ultrasound imaging. Recombinant forms of human albumin have been developed as excipients for vaccines and other drug products, and for the treatment of hypoalbuminaemia and hypovolaemic shock. Albumin solutions are usually available as 4.5% or 5% solutions, which are iso osmotic with plasma, and as 20% or 25% solutions which are hyperosmotic with respect to plasma, and cause a movement of fluid from the extravascular to the intravascular compartment. These concentrated solutions may be used undiluted or may be diluted with a suitable solution, commonly sodium chloride 0.9% or glucose 5%.
Adequate hydration should be maintained and electrolytes monitored in patients receiving hyperosmotic solutions of albumin The amount of albumin solution given will depend upon the clinical condition of the patient and the response to treatment. The following doses have been suggested: acute hypovolaemic shock: an initial dose of 25 g for adults (for example, 500 ml of a 5% solution or 100 ml of a 25% solution) and up to about 1 g/kg for children.
Hypoproteinaemia: a maximum of 2 g/kg daily.
Neonatal hyperbilirubinaemia: 1 g/kg before exchange transfusion.
The rate of infusion should be adjusted according to the indication and patient response, but in general, suggested rates of infusion are up to 5 mL/minute (5% solution) or 1 to 2 mL/minute (20% solution). In plasmapheresis the albumin infusion rate should be adjusted according to the rate of removal. Albumin solutions should not be used for parenteral nutrition.