What patients need albumin and for what conditions?

Albumin is a crucial protein in human blood plasma, responsible for maintaining colloid osmotic pressure and transporting various substances. Historically, its medical use has seen varying recommendations, but recent evidence-based guidelines have clarified which patients need albumin and under what specific conditions for optimal outcomes.

Quick Summary

This article explains which patients require intravenous albumin therapy based on current medical guidelines, focusing on specific clinical applications such as severe burns, critical care scenarios, and complications of liver cirrhosis. It details the conditions that cause albumin deficiency and explains how albumin helps restore critical bodily functions.

Key Points

• Cirrhosis Complications: Albumin is crucial for managing spontaneous bacterial peritonitis (SBP) and large-volume paracentesis in cirrhotic patients to prevent kidney dysfunction and circulatory collapse.

• Critical Fluid Resuscitation: For severe hypovolemic shock or burns, albumin serves as a second-line volume expander when standard crystalloid solutions are inadequate.

• Sepsis Support: In certain cases of septic shock, albumin is used as an adjunct to crystalloids when large fluid volumes are needed.

• Addressing Severe Edema: Albumin with diuretics can be indicated for fluid-overloaded patients with conditions like Adult Respiratory Distress Syndrome (ARDS) or refractory nephrotic syndrome.

• Not a Nutritional Supplement: Albumin is not an effective treatment for chronic hypoalbuminemia due to malnutrition, which should be managed with proper nutritional support.

• Close Monitoring Required: Patients receiving albumin must be carefully monitored for signs of fluid overload, including elevated blood pressure and pulmonary edema.

What is Albumin?

Albumin is the most abundant protein in human plasma, making up approximately 60% of the body's total protein content. Produced exclusively by the liver, its primary roles include maintaining the colloid osmotic pressure (COP) to keep fluid within the blood vessels, transporting hormones, fatty acids, and drugs, and acting as a free radical scavenger.

Clinical Indications for Albumin Therapy

Albumin therapy is not a universal treatment for all cases of low albumin (hypoalbuminemia), as nutritional therapy is often more appropriate for chronic deficiencies. Instead, it is reserved for specific conditions where rapid volume expansion or correction of an acute deficiency is needed. Key clinical indications include liver cirrhosis complications, critical care situations, and specific medical conditions.

Comparing Albumin to Crystalloids

Healthcare providers weigh using albumin (a colloid) versus crystalloid solutions for fluid resuscitation. The choice is condition-dependent. Here is a comparison:

Feature	Albumin (Colloid)	Crystalloids (e.g., Saline, Lactated Ringer's)
Cost	Significantly more expensive.	Much less expensive and widely available.
Primary Function	Increases plasma volume by drawing fluid into circulation via osmotic pressure.	Increases total body water and sodium, increasing plasma volume.
Plasma Volume Expansion	More efficient volume expansion per unit.	Requires larger volumes; much shifts into interstitial space.
Clinical Evidence	Strong for specific conditions like SBP and paracentesis. Limited for routine use in all critical care.	First-line for most resuscitation, with established evidence.
Associated Risks	Potential for fluid overload, remote viral transmission risk.	Risk of hyperchloremic acidosis with large saline volumes.

Cautions and Monitoring

Due to cost and potential risks, albumin use is closely monitored. Patients, especially those with heart or kidney issues, need observation for fluid overload signs like high blood pressure, breathing difficulty, and swelling. For liver disease, specific monitoring ensures correct dosing and prevents complications.

Conclusion

Albumin is a valuable treatment for acute and critical conditions requiring rapid fluid balance restoration. It provides targeted support for complications of liver cirrhosis (like SBP and hepatorenal syndrome) and severe hypovolemia from burns or shock, guided by evidence. Clinicians must consider costs, benefits, and risks for each patient to determine appropriate use and optimize outcomes. For more information on evidence-based guidelines, consult resources like {Link: ScienceDirect https://www.sciencedirect.com/science/article/pii/S001236922400285X}.

Frequently Asked Questions

What is the primary purpose of albumin in the body?

Albumin is the main protein in blood plasma, primarily responsible for maintaining the colloid osmotic pressure. This pressure keeps fluid within the blood vessels, preventing it from leaking into the tissues.

When is albumin used for patients with liver disease?

For liver disease, albumin is used to manage complications of cirrhosis, including spontaneous bacterial peritonitis (SBP), hepatorenal syndrome (HRS), and after large-volume paracentesis to prevent circulatory dysfunction.

Is albumin useful for treating malnutrition?

No, albumin is generally not indicated for treating malnutrition. The correct approach for nutritional deficiency is proper dietary or enteral nutrition, not intravenous albumin, which provides only temporary benefits.

Why is albumin sometimes used for burn victims?

In severe burn cases, particularly after the first 24 hours, albumin is used to help restore plasma volume and maintain colloid osmotic pressure, which is lost as protein-rich fluid leaks from damaged blood vessels.

What are the risks of albumin infusion?

The main risks include hypervolemia (fluid overload), which can lead to complications like pulmonary edema or congestive heart failure. There is also a remote risk of transmitting infections since it is a blood product.

How does albumin help in treating septic shock?

In septic shock, albumin may be used as a volume expander alongside crystalloid fluids, especially when large volumes are needed. It helps restore adequate blood volume and pressure, though it is not a first-line treatment.

Why is monitoring important during albumin therapy?

Monitoring is critical to prevent complications like fluid overload. Healthcare providers must closely track vital signs such as blood pressure, heart rate, and urine output to ensure the correct dosage and infusion rate.

Is albumin safe for newborns?

Albumin is used in some pediatric applications, such as for neonatal hemolytic disease. However, specific precautions and dosage adjustments are necessary, and its use in newborns should be carefully considered.