Usage
Albumin is prescribed for various medical conditions related to low blood volume (hypovolemia) or low albumin levels (hypoalbuminemia). These conditions may include:
- Hypovolemia (low blood volume)
- Hypoalbuminemia (low albumin levels)
- Burns
- Acute respiratory distress syndrome (ARDS)
- Nephrosis
- Renal dialysis
- Cardiopulmonary bypass surgery
- Acute liver failure
- Hemolytic disease of the newborn
- Prevention of central volume depletion after paracentesis due to cirrhotic ascites
- Ovarian hyperstimulation syndrome (OHSS)
It is pharmacologically classified as a plasma expander and volume replacement agent.
Albumin’s mechanism of action involves increasing plasma colloid oncotic pressure. This helps draw fluid from the interstitial space back into the vascular system, thereby restoring blood volume.
Alternate Names
Albumin is also referred to as human albumin. Several brand names exist, including:
- Albuminar-25
- Alburx
- Albutein
- Albuminex
- Plasbumin
- Buminate
- Flexbumin
- Kedbumin
- Macrotec
How It Works
Pharmacodynamics: Albumin exerts its primary effect by raising the plasma colloid oncotic pressure, which in turn increases intravascular volume.
Pharmacokinetics: Albumin is administered intravenously and distributes rapidly within the intravascular compartment. It is metabolized by various tissues throughout the body. The liver is a primary site for albumin catabolism, but kidneys and the gastrointestinal tract also contribute to it. Elimination of albumin breakdown products involves renal and hepatic pathways.
Mode of Action: Albumin exerts its therapeutic effects by increasing osmotic pressure. It binds to water molecules and keeps them within the blood vessels and preventing fluid leak into other tissues.
Dosage
Standard Dosage
Adults:
The standard adult dosage varies depending on the indication and concentration of the albumin solution (5% or 25%). Dosages typically range from 25g to 75g. It’s crucial to adjust dosage based on patient response and monitoring of circulating volume. The maximum daily dose is 2g/kg of body weight.
Children:
Pediatric dosing is weight-based, typically ranging from 0.5 to 1 g/kg per dose. Limited data exists on efficacy in pediatric populations, necessitating cautious administration based on clinical need.
Special Cases:
- Elderly Patients: Infusion rates should be adjusted, particularly for 25% albumin solutions, to minimize the risk of fluid overload.
- Patients with Renal Impairment: Dosage adjustments may be needed based on renal function and dialysis status.
- Patients with Hepatic Dysfunction: Adjustments for impaired metabolism may be needed.
- Patients with Comorbid Conditions: Careful monitoring and dose adjustments are essential in patients with heart failure, hypertension, or other conditions that could be exacerbated by fluid overload.
Clinical Use Cases
Dosage recommendations for specific clinical situations are as follows:
- Hypovolemia: 25g for adults, 2.5g to 12.5g for children.
- Hypoalbuminemia: 50g to 75g for adults.
- Prevention of volume depletion after paracentesis: 8g for every 1000mL of ascitic fluid removed.
- Ovarian hyperstimulation syndrome (OHSS): 50g to 100g over 4 hours, repeated at 4-12 hour intervals as needed.
- Adult respiratory distress syndrome (ARDS): 25g over 30 minutes, repeated at 8 hours for 3 days if necessary.
- Acute nephrosis: 25g together with a diuretic once a day for 7-10 days.
- Burns: Initial dose of 25g after the first 24 hours, followed by adjustments to maintain appropriate plasma protein levels.
- Cardiopulmonary bypass procedures: Initial dose of 25g.
- Hemolytic disease of the newborn: 1g/kg before or during plasma exchange.
Dosage Adjustments
Dose modification is necessary for renal or hepatic dysfunction and other comorbid conditions based on individual patient characteristics.
Side Effects
Common Side Effects:
Nausea, vomiting, fever, chills, rapid heart rate, mild rash, flushing.
Rare but Serious Side Effects:
Hives, cough, difficulty breathing, swelling of the face, lips, tongue, or throat, lightheadedness, weak or shallow breathing, throbbing headache, blurred vision, buzzing in the ears, anxiety, confusion, sweating, pale skin, severe shortness of breath, wheezing, gasping for breath, cough with foamy mucus, chest pain, rapid and uneven heart rate, anaphylaxis, fluid overload.
Long-Term Effects:
Potential long-term effects include edema (swelling) and fluid overload.
Adverse Drug Reactions (ADR):
Clinically significant ADRs may include anaphylaxis or severe allergic reactions.
Contraindications
- Hypersensitivity to albumin or any components of the formulation.
- Severe anemia
- Congestive heart failure
- Renal insufficiency with risk of hemodynamic instability
- Conditions where hypervolemia and its consequences or hemodilution could represent a special risk for the patient: Decompensated cardiac insufficiency, Hypertension, Esophageal varices, Pulmonary edema, Hemorrhagic diathesis, Severe anemia, Renal and post-renal anuria
Drug Interactions
Although specific drug interactions are rare, administering albumin with certain medications may warrant dose adjustments. It is important to be vigilant regarding potential drug interactions and consult resources like the FDA or Drugs.com for a more detailed list of reported drug interactions. Be sure to inform your patients to discuss all medications and supplements they’re taking.
Pregnancy and Breastfeeding
Albumin is categorized as Pregnancy Category C. Animal reproduction studies have not been conducted with albumin. Its safety during pregnancy has not been established in controlled clinical trials. Albumin should be administered cautiously during pregnancy only if the potential benefits outweigh the potential risks to the fetus.
Albumin is present in breast milk. The decision to breastfeed during albumin therapy should consider the risks of infant exposure, the benefits of breastfeeding, and the benefits of treatment for the mother.
Drug Profile Summary
- Mechanism of Action: Increases plasma colloid oncotic pressure, thereby restoring blood volume.
- Side Effects: Common: Nausea, vomiting, fever, chills, rash, flushing. Serious: Anaphylaxis, fluid overload.
- Contraindications: Hypersensitivity to albumin, severe anemia, heart failure, renal insufficiency with risk of hemodynamic instability, and conditions where hypervolemia could be detrimental.
- Drug Interactions: Consult resources like the FDA or Drugs.com for information on potential drug interactions with albumin.
- Pregnancy & Breastfeeding: Category C; use with caution during pregnancy and breastfeeding, considering the risk-benefit profile.
- Dosage: Variable, depending on indication and patient condition. Consult dosage guidelines provided.
- Monitoring Parameters: Hemodynamic parameters, fluid balance, serum albumin levels.
Popular Combinations
Albumin is often used in combination with crystalloid solutions for fluid resuscitation. It can also be co-administered with diuretics in certain conditions like acute nephrosis.
Precautions
General precautions include pre-screening for allergies, metabolic disorders, and organ dysfunction. Specific considerations for pregnant/breastfeeding women, children, and the elderly should be taken, adjusting dosage as needed. Advise patients to follow any specific restrictions regarding lifestyle factors, such as diet and alcohol consumption.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Albumin?
A: The dosage varies depending on the patient’s age, condition, and the albumin concentration (5% or 25%). Standard adult doses range from 25g to 75g, while pediatric doses are weight-based (0.5-1g/kg). Dosage should be adjusted based on patient response and circulating volume.
Q2: What are the primary uses of Albumin?
A: Albumin is primarily used to treat hypovolemia and hypoalbuminemia associated with various conditions such as burns, ARDS, nephrosis, and liver failure.
Q3: What are the common side effects of Albumin?
A: Common side effects include nausea, vomiting, fever, chills, mild rash, and flushing.
Q4: Are there any serious side effects to be aware of with Albumin?
A: Yes, rare but serious side effects include anaphylaxis, fluid overload, pulmonary edema, and circulatory embarrassment.
Q5: What are the contraindications for Albumin administration?
A: Contraindications include hypersensitivity to albumin, severe anemia, heart failure, and renal insufficiency with risk of hemodynamic instability.
Q6: Can Albumin be administered during pregnancy?
A: Albumin is a Pregnancy Category C drug. Its safety during pregnancy hasn’t been fully established, so it should be used cautiously only if benefits outweigh risks.
Q7: How should Albumin be administered?
A: Albumin is administered intravenously, with the rate and volume adjusted according to the patient’s condition. 25% solutions should be infused slowly to avoid circulatory overload.
Q8: What parameters should be monitored during Albumin therapy?
A: Monitor hemodynamic parameters (blood pressure, heart rate), fluid balance (intake and output), and serum albumin levels.
Q9: Is there a maximum daily dose for Albumin?
A: Yes, the maximum daily dose is 2g/kg of body weight.
Q10: What are common drug combinations used with Albumin?
A: Albumin is often used in combination with crystalloids for fluid resuscitation, and occasionally with diuretics for conditions like acute nephrosis.
