1. Clinical Overview
Albumin (5%) is a sterile, non-pyrogenic, iso-oncotic (iso-osmotic) colloidal plasma protein fraction derived from pooled human plasma. It is a 50 g/L solution of human albumin in a buffered diluent, primarily used for volume expansion and maintenance of colloid osmotic pressure (oncotic pressure) in the intravascular compartment. In India, it is a critical therapeutic agent for managing hypovolemic shock, burns, and hypoalbuminemic states, sourced from voluntary, non-remunerated blood donors and subjected to rigorous viral inactivation/removal steps as per Indian Pharmacopoeia and DCGI guidelines.
| Onset | Duration | Bioavailability |
|---|---|---|
| Volume expansion effects begin within 15-30 minutes of intravenous infusion. | The intravascular volume expansion effect typically lasts for 12-24 hours, depending on the patient's clinical condition and capillary integrity. | 100% (administered intravenously). |
2. Mechanism of Action
Human albumin (5%) is iso-oncotic with plasma. Its primary mechanism is to increase the intravascular colloid osmotic pressure (oncotic pressure), which draws fluid from the interstitial space into the intravascular compartment, thereby expanding plasma volume. It does not carry oxygen. It also serves as a transport protein for various ligands and contributes to antioxidant activity via its free thiol group.
3. Indications & Uses
- Hypovolemic Shock (surgical, traumatic)
- Severe Burns (after the first 24 hours for plasma volume maintenance)
- Hypoalbuminemia (with associated edema or ascites, e.g., in nephrotic syndrome, cirrhosis, acute pancreatitis)
- Therapeutic Plasma Exchange (as a replacement fluid)
4. Dosage & Administration
Adult Dosage: Dose is highly individualized based on patient's condition, volume status, and ongoing losses. General guide: Initial dose of 25 g (500 mL of 5%) infused IV. Rate: 1-2 mL/min initially, adjust based on response. In shock: 500-1000 mL rapidly, repeated as needed. Maintenance: Dose and rate guided by clinical and hemodynamic monitoring.
Administration: For IV use only. Use a sterile infusion set with a filter (optional, 15-micron filter sometimes recommended). Can be administered without dilution. Do not mix with other drugs, protein hydrolysates, or alcohol-containing solutions. Compatible with most IV fluids (e.g., 0.9% NaCl, 5% Dextrose) but should not be mixed in the same container. Patient should be monitored for vital signs, pulmonary edema, and allergic reactions during infusion.
5. Side Effects
Common side effects may include:
- Chills
- Mild fever (pyrexia)
- 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) | Synergistic effect for mobilizing edema fluid in hypoalbuminemic states. Administer furosemide after albumin for optimal effect. | Low (Beneficial) |
| Vasopressors (e.g., Noradrenaline) | Albumin may improve hemodynamic response by optimizing preload. | Low (Beneficial) |
7. Patient Counselling
- Inform the doctor/nurse of any history of allergies, especially to blood products.
- Report any discomfort during the infusion immediately (chills, itching, breathing difficulty, chest tightness).
- Understand that this is a plasma-derived product with a remote risk of infection transmission.
8. Toxicology & Storage
Overdose: Symptoms of hypervolemia and circulatory overload: Severe headache, dyspnea, pulmonary edema (pink frothy sputum, rales), jugular venous distension, hypertension, tachycardia, and potentially cardiac failure.
Storage: Store at 2°C to 25°C (refrigeration is recommended but not mandatory for some brands as per labeling). Do not freeze. Protect from light. Keep in outer carton. Do not use if the solution is cloudy or contains particles. Once the bottle/pouch is punctured, use immediately. Do not use after the expiry date.