1. Clinical Overview
Albumin (20%) is a sterile, pyrogen-free, concentrated human serum albumin solution prepared from pooled human venous plasma. It is a hyperoncotic colloidal plasma volume expander containing 200 mg/mL of albumin, with approximately 130-160 mmol/L of sodium. In the Indian context, it is a critical, high-value biological used primarily in hospital settings for acute volume resuscitation and oncotic pressure correction.
| Onset | Duration | Bioavailability |
|---|---|---|
| Onset of plasma volume expansion is immediate upon intravenous infusion. | The duration of effect on plasma volume can persist for several hours, but the intravascular half-life of the albumin molecule is approximately 15-20 days. | 100% (Administered intravenously). |
2. Mechanism of Action
Albumin (20%) is a hyperoncotic solution. Its primary mechanism is to increase the oncotic (colloid osmotic) pressure within the intravascular compartment. This draws fluid from the interstitial space into the circulation, thereby expanding plasma volume. Each gram of albumin can draw approximately 18 mL of fluid into the intravascular space. It also serves as a carrier protein and contributes to acid-base buffering capacity.
3. Indications & Uses
- Hypovolemic Shock (for volume resuscitation)
- Severe Hypoalbuminemia (Serum Albumin < 2.0 g/dL) with associated edema or ascites
- Therapeutic Plasma Exchange (as a replacement fluid)
- Large Volume Paracentesis (>5L) for prevention of Post-Paracentesis Circulatory Dysfunction (PPCD)
4. Dosage & Administration
Adult Dosage: Dose is highly individualized. For shock: 1-2 g/kg (5-10 mL/kg of 20% solution), not to exceed 250 g in 48 hours. Repeat based on clinical response. For hypoalbuminemia: 1 g/kg/day, monitor serum albumin. Post-paracentesis: 8 g per liter of ascitic fluid removed.
Administration: For IV use only. 20% solution is hyperoncotic and MUST be infused slowly. Initial rate: 1-2 mL/min for the first 15-30 minutes. If tolerated, rate can be increased but should generally not exceed 4-5 mL/min. Can be administered undiluted or diluted with Normal Saline or 5% Dextrose. Do not use sterile water for injection (risk of hemolysis). Use a separate infusion line. Do not mix with other drugs, protein hydrolysates, or alcohol solutions.
5. Side Effects
Common side effects may include:
- Chills
- Fever (pyrogenic reaction)
- Flushing
- Nausea
- Headache
6. Drug Interactions
| Drug | Effect | Severity |
|---|---|---|
| ACE Inhibitors (e.g., Enalapril, Ramipril) | Increased risk of anaphylactoid reactions, especially during LDL apheresis with albumin. | Moderate |
| Loop Diuretics (e.g., Furosemide) | Concomitant use can be synergistic in mobilizing edema fluid (albumin draws fluid intravascularly, furosemide promotes diuresis). | Low (Therapeutic) |
| Vasopressors | Albumin volume expansion may potentiate pressor effects. Monitor blood pressure closely. | Moderate |
7. Patient Counselling
- Inform the doctor/nurse immediately of any chills, fever, itching, rash, breathing difficulty, or chest/back pain during the infusion.
- Report any sudden weight gain, swelling in feet/ankles, or shortness of breath after treatment.
8. Toxicology & Storage
Overdose: Symptoms of severe hypervolemia: Acute pulmonary edema (dyspnea, rales, cyanosis), congestive heart failure, distended neck veins, hypertension followed by potential cardiovascular collapse.
Storage: Store at 2°C to 25°C. Do not freeze. Keep in outer carton to protect from light. Do not use after the expiry date. Once the vial is punctured, use immediately. Do not use if the solution is cloudy or contains particles. Do not heat the solution.