Why is Albumin Given in the Hospital?

January 1, 2026 •

3 min read

Albumin is the most abundant protein in human blood plasma, produced by the liver, and accounts for up to 80% of the blood's oncotic pressure. This critical protein is frequently administered intravenously in hospital settings to manage a variety of severe medical conditions where the body's natural levels have fallen dangerously low.

Quick Summary

Albumin is administered in hospitals for severe conditions including sepsis, liver disease, and major burns. It helps increase blood volume, prevent fluid leaks, and reduce complications like kidney failure. The protein's functions extend beyond simple volume expansion to include anti-inflammatory and antioxidant effects.

Key Points

Restores Blood Volume: Albumin is given to treat low blood volume (hypovolemia) from conditions like severe dehydration, bleeding, or burns by pulling fluid into the blood vessels.
Manages Liver Disease Complications: In patients with cirrhosis, albumin is used to manage complications like ascites (fluid in the abdomen), and to prevent kidney failure and circulatory dysfunction following large-volume fluid removal.
Combats Sepsis and Shock: For severe sepsis and septic shock, albumin can be used for fluid resuscitation to restore blood pressure, although its effectiveness remains debated across all septic patient groups.
Reduces Burn-Related Fluid Requirements: After initial resuscitation, albumin is used in severe burn patients to help reduce the massive amount of fluid needed to stabilize them, decreasing the risk of compartment syndrome.
Supports Other Critically Ill Patients: It is also used in specific cases such as cardiopulmonary bypass surgery and severe ovarian hyperstimulation syndrome to maintain critical fluid balance.
Carries and Binds Substances: Beyond volume effects, albumin transports vital substances like hormones and fatty acids, and its binding properties help detoxify the body and regulate inflammation.

Albumin: A Crucial Component in Critical Care

Albumin is a powerful, naturally occurring protein with diverse physiological roles. Produced exclusively by the liver, it is vital for maintaining plasma volume, transporting essential substances, and modulating the immune system. When severe illness, injury, or chronic disease compromises the body's ability to produce or retain albumin, medical professionals intervene with intravenous infusions to restore balance.

Core Functions of Albumin

Albumin performs several key functions that are essential for survival. When these functions are impaired, the consequences can be life-threatening. The protein's main roles include:

Maintaining Oncotic Pressure: This is albumin's most well-known function. It helps keep fluid within blood vessels, preventing leakage into tissues and causing edema.
Transportation: Albumin carries hormones, vitamins, enzymes, fatty acids, and drugs, affecting their distribution and efficacy.
Antioxidant Activity: The protein protects against damage from free radicals that accumulate during illness.
Anti-inflammatory Effects: Albumin can bind to inflammatory cytokines, helping to modulate the immune response.

Clinical Scenarios for Albumin Administration

Albumin administration is based on specific clinical needs rather than just low lab values. Its use is guided by the underlying condition.

Sepsis and Septic Shock

Sepsis is a life-threatening complication of infection often causing a dramatic drop in blood volume and pressure. In severe sepsis and septic shock, albumin is used for fluid resuscitation, especially when large volumes are needed. Research like the ALBIOS trial has studied its use, with some analyses suggesting a potential mortality benefit in septic shock, although results vary.

Liver Cirrhosis and Its Complications

Liver cirrhosis impairs albumin production, leading to low blood levels. This can cause complications like ascites (fluid in the abdomen) and hepatorenal syndrome (a form of kidney failure). Albumin infusions help prevent and treat these issues, particularly after removing large volumes of ascites fluid. For spontaneous bacterial peritonitis (SBP), albumin has been shown to reduce mortality and renal impairment.

Major Burns and Trauma

Following severe burns, large amounts of plasma and protein leak from damaged capillaries. This fluid shift can cause hypovolemic shock. Albumin infusions after the initial 24 hours help restore blood volume, draw fluid back from tissues, and potentially reduce the total fluid needed for resuscitation.

Other Indications

Albumin is also used in other situations:

Cardiopulmonary Bypass: As a priming fluid.
Ovarian Hyperstimulation Syndrome (OHSS): To manage severe cases.
Hemodialysis-Induced Hypotension: A second-line treatment when crystalloids aren't effective.

Comparison of Albumin vs. Crystalloids in Resuscitation

The choice between albumin (a colloid) and crystalloids (like saline) is a key consideration in critical care. Here's a comparison:


Feature	Albumin (Colloid)	Crystalloids (e.g., Normal Saline)
Composition	Large protein molecules	Small electrolyte and water molecules
Intravascular Persistence	Remains in blood vessels longer	Quickly leaves blood vessels
Volume Expansion	Highly effective, can exceed infused volume effect	Less efficient, requires larger volumes
Cost	Significantly more expensive	Considerably less expensive
Potential Side Effects	Fluid overload, allergic reactions, potential bleeding	Can cause hyperchloremic acidosis with large volumes

Risks and Considerations

Albumin administration carries risks. Fluid overload is a concern, especially in patients with heart or kidney issues. Allergic reactions and rare transmission of blood-borne pathogens are also possibilities. The decision to use albumin must weigh these risks against potential benefits for the patient.

Conclusion

Albumin is a valuable therapeutic agent for specific, severe conditions in hospitals. Its ability to maintain oncotic pressure, transport substances, and exert anti-inflammatory effects is crucial for treating hypovolemia, managing liver cirrhosis complications, and supporting burn patients. However, it is not a universal treatment, and its cost and risks require careful consideration. The decision to administer albumin is complex, based on a comprehensive assessment of the patient's condition, fluid status, and overall health. Ongoing research aims to further clarify its optimal use.

Frequently Asked Questions

The primary reason for giving albumin is to increase and maintain circulating blood volume. It does this by increasing the oncotic pressure in the bloodstream, drawing fluid from the tissues back into the vessels to treat conditions like shock and major burns.

The research on whether albumin is universally superior to crystalloid fluids (like saline) for resuscitation is mixed. While it can be more effective for volume expansion in specific contexts, some studies show no significant mortality benefit over cheaper alternatives, and there are risks associated with its use.

While low albumin levels are often a sign of malnutrition, administering albumin intravenously is not a recommended treatment for chronic malnutrition. The effects are temporary, and the best long-term solution is addressing the underlying nutritional deficiency.

The risks of albumin infusion include fluid overload, which can lead to heart failure or pulmonary edema, and allergic reactions. There is also a very small risk of transmitting infectious diseases since it is a blood product, though modern processes significantly reduce this.

The difference lies in their concentration. A 5% solution is iso-oncotic with blood plasma and is often used for simple volume replacement. A 25% solution is hyper-oncotic, meaning it is more concentrated and can pull significantly more fluid from the tissues into the blood vessels, and is used when fluid or sodium restriction is necessary.

A patient receiving albumin is closely monitored for vital signs like breathing, pulse, and blood pressure to watch for signs of fluid overload or adverse reactions. Blood electrolyte levels and kidney function are also carefully tracked throughout treatment.

No, albumin is not used for all liver patients. It is most effective for specific complications like hepatorenal syndrome, preventing issues after large-volume paracentesis, and spontaneous bacterial peritonitis. In stable chronic liver disease, simply having low albumin does not warrant infusion.