Albumin


Adult Dose:
 Note: Use 5% solution in hypovolemic patients or intravascularly-depleted patients. Use 25% solution in patients in whom fluid and sodium intake is restricted
  • Usual dose:
    • IV: 25 g; initial dose may be repeated in 15 to 30 minutes if response is inadequate.
       
  • Adult respiratory distress syndrome: IV:
    • 25 g over 30 minutes (in combination with furosemide); may repeat at 8 hours (if necessary) for 3 days; titrate to fluid loss and normalization of serum total protein. Patients enrolled into the clinical trial had hypoproteinemia (total protein <6 g/dL).
       
  • Hypovolemia: 5% albumin: IV:
    • Initial: 12.5 to 25 g (250 to 500 mL); repeat after 15 to 30 minutes as needed (if hemodynamic stability is not achieved). Note: May be considered after inadequate response to crystalloid therapy and when nonprotein colloids are contraindicated. The volume administered and the speed of infusion should be adapted to individual response.
       
  • Large-volume paracentesis: IV:
    • Manufacturer's labeling:
      • 25% albumin: 8 g for every liter removed.
    • Alternate recommendations:
      • 25% albumin: 5 to 10 g for every liter removed (usual dose cited: 8 g for every liter removed) (Bernardi 2012; Moore 2003; AASLD [Runyon 2012]) or 50 g total for paracentesis >5 L (ATS 2004). Note: Administer soon after the procedure to avoid postprocedural complications (eg, hypovolemia, hyponatremia, renal impairment) (Moore, 2003).
  • Ovarian hyperstimulation syndrome (treatment): 25% albumin: IV:
    • 50 to 100 g over 4 hours; repeat at 4 to 12 hours intervals as needed.
       
  • Plasma exchange: 5% albumin: IV:
    • Titrate dose to plasma volume removed during procedure.
       
  • Spontaneous bacterial peritonitis (treatment) (off-label use):
    • 25% albumin: IV: Initial: 1.5 g/kg within 6 hours of diagnosis (in conjunction with appropriate antimicrobial therapy), followed by 1 g/kg on day 3 (Abd 2012; AASLD (Runyon 2012); Sort 1999). Note: Clinical trials used albumin 20%; the difference in concentration compared with 25% albumin is deemed to be clinically inconsequential.
Pediatric Dose:
Note: 5% should be used in hypovolemic patients or intravascularly-depleted patients. 25% should be used in patients in whom fluid and sodium intake must be minimized
Hemolytic disease of the newborn: Infants: IV:
  • 1 g/kg/dose of 25% albumin prior to or during exchange transfusion

Hypovolemia:

  • Infants and Younger Children: IV:
    • 0.5 to 1 g/kg/dose (10 to 20 mL/kg/dose of albumin 5%); repeat in 30 minute intervals as needed
  • Older Children and Adolescents: IV:
    • 12.5 to 25 g (250 to 500 mL of albumin 5%); repeat in 30 minute intervals as needed.