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Abstract
Summary
90 Role of Albumin in Burn and Other
Conditions
Role of albumin in burn
Hypoalbuminemia is a common clinical deficiency in burn
patients and is associated with complications related to
increased extra vascular fluid including; Edema, abnormal
healing and susceptibility to sepsis. Patients with albumin
levels 2 g/dL had a mortality risk of 80%. At admission, the
albumin level could be used as a sensitive and specific marker
of burn severity and an indicator of mortality (Becerra et al.,
2013).
Major burn injuries (table 9) (Fig. 9) produce profound
and prolonged increases in capillary permeability within
the burn wound microcirculation starting immediately
peaking around 8 hours post-burn and persisting for at
least 48 hours. Albumin being the most abundant of all
plasma proteins in the body is particularly affected in
burns and other syndromes involving capillary leakage.
Though it is reported to be harmful in the first 24 hrs, its
use is justified after 24 hrs in profoundly
hypoalbuminemic patients, as it favors reabsorption of
edema (Ramakrishna, 2013).
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91
Table (9): A description of the traditional and current
classifications of burns
Nomenclature Traditional nomenclature
Depth Clinical findings
Superficial thickness First-degree Epidermis involvement
Erythema, minor pain, lack of
blisters
Partial thickness —
superficial
Second-degree Superficial (papillary) dermis Blisters, clear fluid, and pain
Partial thickness —deep
Second-degree Deep (reticular) dermis
Whiter appearance, with
decreased pain. Difficult to
distinguish from full thickness
Full thickness
Third- or fourthdegree
Dermis and underlying
tissue and possibly fascia,
bone, or muscle Hard,leather-like eschar ,purple fluid, no sensation (insensate)
(Townsend et al., 2004).
Fig. (9): Burns are classified according to the depth (degree), the surface area (role of nine) and the causes (Townsend et al., 2004).
Burned patients are a specific group in whom albumin may have a beneficial role. In addition to its well-known oncotic properties, albumin has many other physiological roles that
might support hypoalbuminemia correction, such as the
binding of endogenous and exogenous substances,
anticoagulant effects, maintenance of acid-base status,
modulation of apoptosis and protective effects on the
microcirculation (Becerra et al., 2013).
Summary
92 Another issue to consider is the role of nutritional support. The
best possible nutrition and nutritional route for each individual
must be guaranteed. Enteral nutrition is preferable, but if this
treatment cannot provide the minimum requirements to
suppress the catabolic phase and induce the anabolic phase or
cannot be used for any reason. The parenteral route or
combined enteral and parenteral routes should be used to
ensure the provision of macronutrients (specifically proteins)
in higher than normal quantities. For this strategy to succeed,
the modulation of the inflammatory response, immune
strengthening and the optimal management of burned skin
extensions is required in addition to nutritional support to
avoid immediate and late protein leakage (Guastavino et al.,
2005).
One randomized prospective trial has compared albumin with
crystalloid solutions in 79 patients with severe burn injury.
Patients were treated with either lactated Ringer’s (LR) or a LR
- 2.5% albumin solution during the initial 24-hours to maintain
urine output and stabilize vital signs. During the second day,
all patients received albumin 0.3 to 0.5mL/kg per percent
burned surface area to restore plasma volume. The use of
albumin was associated with a beneficial increase in cardiac
index and a detrimental increase in lung water values and
pulmonary edema. These findings suggest that the benefit
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93
derived from the exogenous administration of albumin during
thermal injury may be limited by the increased capillary
permeability that occurs during the initial 24 hours following
the injury. After 24 hours, the vascular endothelium may
regain its normal degree of permeability, but the skin and areas
of direct thermal injury often continue to manifest significant
amounts of intracellular edema for several weeks. Therefore,
immediate fluid resuscitation is best accomplished by
administration of crystalloid and after 24 hours, exogenous
albumin produces more effective plasma volume expansion
(Erstad et al., 2011).
Albumin use in neurosurgical critical care
Primary indications were treatment of Subarachnoid
Hemorrhage (SAH)-induced vasospasm and maintenance of
CPP. However, there is no evidence to determine which fluid
selection is most appropriate for these indications. Based on
many survey results, crystalloid appears to be the fluid of
choice. However, albumin also is used consistently among
neurosurgeons. National guidelines continue to prefer
crystalloids to albumin for vasospasm. The Saline versus
Albumin Fluid Evaluation (SAFE) study suggested that
patients with Traumatic Brain Injury (TBI) resuscitated with
albumin had a higher mortality rate than those resuscitated
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94
with saline. However, albumin (25%) may be recommended
for CPP protocols if cerebral edema is present (Cassels, 2007).
The optimal fluid choice for prevention of secondary ischemic
injury after neurologic insult is unknown. For vasospasm or to
maintain CPP, large volumes of fluid may be required.
Proponents of albumin are concerned that the crystalloid
volume required for optimizing cerebral hemodynamics may
increase the risks of cerebral edema or systemic organ
compromise (e.g., pulmonary edema, chronic heart failure).
Crystalloid products also may exacerbate complications
accompanying neurologic insult (e.g., diabetes insipidus,
syndrome of inappropriate antidiuretic hormone or acid-base
disturbances). Colloid solutions have the potential to produce
desired end points without complications from fluid overload.
The choice of colloid is limited because of bleeding
complications reported with synthetic colloids in patients with
underlying cerebrovascular injury. In contrast with synthetic
colloids, albumin has not been associated with severe adverse
effects in the neurosurgical population. In fact, recent animal
data suggest potential neuroprotection in a rat model of acute
ischemic stroke (Kimberly et al., 2003).
Hypervolemic-hemodilution-hypertension ”triple H” therapy,
is a strategy used to increase blood flow to the brain and 95 decrease the risk of vasospasm after subarachnoid hemorrhage. This type of hyperdynamic management and manipulation of
blood viscosity offers a rapid means of counteracting the
reduction in cerebral and circulating blood volume that
generally occurs with vasospasm. Triple H therapy
theoretically improves blood flow to regions of hypoperfusion
(Kimberly et al., 2003).
Treatment of cerebral vasospasm with triple-H therapy may
reduce the delayed neurologic deficits and the significant
morbidity associated with this condition. Because of the
increased myocardial oxygen demand and decreased delivery
associated with hypertension and haemodilution, this therapy
may be poorly tolerated in patients with severe left ventricular
dysfunction and heart failure. SAH patients with severe
neurogenic cardiac injury and evidence of heart failure who
cannot tolerate triple-H therapy may benefit from placement of
an intra-aortic balloon pump to increase cerebral perfusion
pressure in the setting of vasospasm (Kopelink and Zaroff,
2007). Role of albumin in cardiac disease Heart Failure (HF) patients with hypoalbuminemia have a
greater than 2-fold increased risk of mortality compared to
those without hypoalbuminemia, even after adjustment for96
multiple prognostic factors. Hypoalbuminemia in patients with
HF may result from hemodilution, malnutrition, chronic
inflammation, infection, proteinuria and other mechanisms.
Hypoalbuminemia with a resulting reduction in colloid
osmotic pressure can influence the degree of pulmonary
congestion as well as HF symptoms. Many studies identify
albumin levels as a simple biomarker for identifying patients
with HF who are at increased risk for urgent heart transplantation and death. Further investigation into
mechanisms underlying hypoalbuminemia is warranted and may result in identifying potential novel targets for HF therapy (Horwich et al., 2011).
Patients undergoing cardiopulmonary bypass have marked
dilution of intravascular colloid oncotic pressure. During the
early postoperative period these patients typically require
significant volume replacement due to peripheral vasodilation.
The best volume expander in this setting is albumin and it is
essential that the albumin be immediately available when
needed. The use of albumin for volume expansion appears to be associated with a reduced incidence of mortality after
CABG surgery when compared to non-protein colloid
treatment (Barclay et al., 2003).
Role of albumin in acute respiratory distress syndrome
(ARDS) Sepsis is the leading cause of death in the ICU and the most
common cause of ARDS occurring in 30-40 of patients. In patients suffering from ARDS the alveolar-capillary barrier
permeability is increased due to inflammation, resulting in
extravasation of protein-enriched fluid into the alveoli. In turn,
the presence of pulmonary exudate in the alveoli, as well as the
inactivation of lung surfactant can result in life-threatening
hypoxemia, impaired CO2 elimination and decreased lung
compliance (Uhlig et al., 2014).
Thus, mechanical ventilation is often required in ARDS
patients in order to improve oxygenation and alleviate the
work of breathing. The use of low tidal volumes and moderateto-
high levels of positive end-expiratory pressure (PEEP) can
reduce mortality in severe ARDS patients. As it is a
multifactorial syndrome patient with ARDS face reduction of
intravascular volume during the course of disease. In order to
counteract these episodes, fluid therapy needs to be instituted
promptly. There are many randomized clinical trials
investigating the effects of colloids in ARDS patients. Based
on their findings, colloid therapy with albumin improved
oxygenation but did not affect mortality (Uhlig et al., 2014).
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In patients with established pulmonary insufficiency,
intrapulmonary shunt was significantly improved with albumin
administration. Hypoproteinemic patients with established
ARDS treated with a combination of albumin and furosemide
achieved significant diuresis and weight loss with concomitant
40% improvements in oxygenation and sustained
improvements in haemodynamic stability. Independent of
colloid administration, management of patients with ARDS by
means of a fluid restrictive strategy may benefit both
hydrostatic and oncotic pressures and has been shown to
reduce the extravascular lung water content while shortening
the duration of mechanical ventilation (9 versus 28 days) and
producing trends toward reduced ICU length of stay and
mortality (Matthay et al., 2012).
Hypoalbuminemia is associated with a negative weaning
outcome in patients on mechanical ventilator support. Based
on the study by Mendez and colleagues in 2005, clinical
benefit was demonstrated when albumin levels > 3 g/dl were
obtained. Mechanically ventilated patient will have failure in
weaning was 6 times more likely in subjects with serum
albumin < 3 mg/dl (Chan et al., 2011)
99 Role of albumin in renal disease
I.Acute renal failure
The development of acute tubular necrosis is associated with
reductions in renal blood flow, although volume expansion
does not linearly increase glomerular filtration or consistently
improve renal function. Albumin administration to patients
with hypovolemia reduces oliguria compared with crystalloids.
The finding that resuscitation of sepsis patients with
hydroxyethyl starch (HES) increases the risk of acute renal
failure by 2.6 times, compared with patients receiving gelatin,
is complicated by infusion volume differences between groups
(Pockaj et al., 2004).
Septic patients with acute renal failure are poorly tolerant to
fluid removal during dialysis and frequently experience
hemodynamic deterioration related to abnormal vascular
resistance. In patients with severe sepsis requiring hemodialysis, albumin priming of the dialysis circuit results in more stable hemodynamics and increases filtration volume by
45 to 60%. Cirrhosis-related abnormalities in renal function
are related to circulatory dysfunction with a reduction in
systemic vascular resistance and renal vasoconstriction.
Administration of albumin has a favorable effect on renal
blood flow and glomerular filtration rate only in patients with
100 early renal dysfunction. The failure of fluid resuscitation in
hepatorenal syndrome may relate to the inability to expand
effective blood volume because of splanchnic vasodilation
(Moller et al., 2005).
II. Chronic renal failure
Chronic renal failure with oliguria or anuria complicates fluid
management during critical illnesses, particularly when cardiac
disease co-exists. Dialysis-related hypotension likely occurs
more frequently in ICU patients than the 20-30% incidence
observed in ambulatory dialysis patients and intradialytic
hypotension may result in the administration of volume
expanders and vasopressors, thus hindering the goals of fluid
and electrolyte removal necessary for optimal patient
management. In ambulatory patients experiencing intradialytic
hypotension, both albumin and hydroxyethyl starch (HES)
successfully restore intravascular volume and prevent
subsequent hemodynamic compromise compared with
hypertonic or isotonic crystalloid solutions. The logical
extrapolation of these results to critically ill patients requires
confirmation in clinical trials (Van der Sande et al., 2000).
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Associations of Pre-transplant Serum Albumin with Posttransplant
Outcomes in Kidney Transplant Recipients
Lower pre-transplant serum albumin concentration during
hemodialysis treatment period was associated with worse
post-transplant short- and long-term outcomes including higher
risk of delayed graft function, increased all causes of
cardiovascular death and higher risk of graft failure. Clinical
trials to examine interventions to improve nutritional status in
transplant-waitlisted hemodialysis patients and their impacts
on post-transplant outcomes are indicated (Molnar et al.,
2011).
III. Nephrotic syndrome
Nephrotic syndrome is a common type of kidney disease
characterized by massive proteinuria, hypoalbuminemia and
edema, although additional clinical features such as
hyperlipidemia are also usually present. Patient with this
condition often show peri- orbital swelling with or without
generalized edema. The disease is due to development of
structural and functional defects in the glomerular filtration
barrier, resulting in its inability to restrict urinary loss of
protein. Hypoalbuminemia and edema develop when the rate
of urinary loss of albumin exceeds the ability of the liver to
synthesize it (Gbadegesin and William, 2008).
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Patients with nephrotic syndrome have increased total body
fluid and sodium during active disease. General measures to
control edema include salt restriction, moderate fluid
restriction, and judicious use of diuretics. Dietary
recommendations include maintenance of protein intake, as
well as avoidance of saturated fats that can worsen
hyperlipidemia (Gbadegesin and William , 2008).
The diuretic effect of furosemide is directly related to the
amount and rate of the drug excreted in urine. The presence of
massive proteinuria and hypoalbuminemia in patients with
nephrotic syndrome alters the pharmacokinetics of furosemide.
The resistance of the nephron to loop diuretics is proportional
to the degree of hypoalbuminemia. This is due to over
reabsorption of sodium and an increased number of sodium
pumps in distal convoluted tubule, connecting tubule, and
cortical collecting duct, despite the deficient proximal
reabsorption of the molecule. Since thiazides inhibit the
furosemide -induced over reabsorption of sodium in distal
tubule, coadministration of furosemide and thiazide is
commonly practiced to overcome diuretic resistance
(Doungngern et al., 2012).
Because the intravascular volume status in patient with
nephrotic syndrome is typically low, diuretics should generally
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be used only when significant intravascular depletion has been
either excluded or corrected. Typically correction of
intravascular depletion can be achieved by initiating
intravenous 25% albumin at 1-2 g/kg/d either as a continuous
infusion or divided every 6-8 hours. Albumin treatment should
continue for 4 to 6 hours before initial administration of
diuretics to minimize the risk of worsening any intravascular
volume depletion that may be present (Doungngern et al.,
2012).
In an attempt to overcome diuretic resistance in patients with
nephrotic syndrome, many trials of albumin co administration
have been conducted. Many of these studies revealed that
albumin had an additive diuretic effect. Co-administration of
albumin moderately potentiated the action of furosemide in
patients with nephrotic syndrome by the changes of
pharmacodynamics, but not pharmacokinetics parameters of
furosemide. from these results, albumin infusion before
furosemide administration can be used to overcome diureticresistance
patients with nephrotic syndrome unresponsive to
maximal doses of furosemide (Sanjay et al., 2008).
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Albumin in Patients Receiving Total Parenteral Nutrition
(TPN)
In a study evaluating the role of albumin in patients with
hypoalbuminaemia and receiving TPN, Brown and colleagues
in 2000 evaluated 61 patients with serum albumin
concentrations below 3.0 g/dL. Patients in Group I received a
TPN formulation plus 25 to 37.5 g/day of albumin for 5 days
or until the serum albumin concentration increase to above
3.0g/dL, Patients in Group II received only TPN. Nitrogen
balance studies were used to adjust the TPN formulation in
both groups. Although there was no significant difference
between the two groups with respect to days on TPN, length of
stay, or mortality, there were significant reductions in the
number of morbid events and complications in Group I when
compared with Group II (Foley et al., 2000).
The second study was conducted in elderly patients with serum
albumin concentrations below 2.5 g/dL. Of the 40 patients
admitted into the study, 18 were randomized to receive 25 to
50 g/day of 25% albumin until the albumin concentration
increase to above 2.5g/dL. The control group received the
standard TPN formula without albumin. Researchers failed to
show any significant benefit from the addition of albumin to
TPN in these patients. The use of albumin infusions in the
chronic phase of hypoalbuminemia is unjustified. The
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administration of amino acids or the oral intake of either
protein or amino acids is more cost-effective than human
albumin infusion in these patients (Foley et al., 2000).
Based on the available evidence, the addition of albumin to
parentral nutrition (PN) solutions is not recommended. The
potential for complications due to infection and physical and
chemical incompatibility and instability exists. Adding
albumin to PN solutions can affect infusion flow rates and
pump pressures, thereby compromising the appropriate
delivery of PN solutions to patients. The risk of glycosylation
and related complications as aluminum contamination,
outweigh potential benefits of albumin administration via PN
solution (Lindsay et al., 2006).
Albumin and Plasmapharesis
Removal of large volumes of plasma (usually 50 ml/kg)
requires replacement with a solution to maintain the colloid
pressure. The solution used was initially fresh frozen plasma,
but this was progressively replaced by pasteurized albumin
solution, when patients did not have coagulation problems.
Synthetic plasma expanders were used in part to reduce the
price of therapeutic exchange and tolerance seemed good
(Schneider, 2000).
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A study was made in 1997 comparing the tolerance and the
cost of three replacement fluids in plasmapheresis: albumin
4% alone, albumin 4%+ dextran 40, or albumin 4%+
hydroxyethylstarch 6%. The only difference between the three
groups was a decrease in serum protein concentration in the
second and third groups after the exchange with no difference
in colloid oncotic pressure. The utilization of
hydroxyethylstarch 6% or dextran 40 with albumin 4% was
clinically well tolerated and lowers the cost by 12%. These
results are encouraging for studies of a higher percentage of
synthetic plasma expanders in substitution solutions used in
plasmapheresis (Mulvihill et al., 2000).
Role of albumin in Ovarian Hyperstimulation Syndrome
(OHSS)
OHSS is a serious complication of ovulation induction, almost
always presents either after hCG administration in susceptible
patients or during early pregnancy. Its cardinal features are
marked ovarian enlargement and an increase in capillary
permeability with the consequent acute third-space fluid
sequestration and its related morbidity. Despite many years of
clinical experience, the pathphysiology of OHSS is poorly
understood, there is no reliable test to predict patients who will
subsequently develop severe OHSS and there are no precise
methods to completely prevent severe OHSS. Patients with
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severe OHSS associated with hemoconcentration,
hypovolemia, thrombo-embolism, severe dyspnea, electrolyte
imbalance, elevated creatinine, elevated liver enzymes,
respiratory distress should be treated in an intensive care unit.
Patients should be closely intensive monitored in the ICU
while the appropriate palliative measures are taken (Orvieto,
2013).
The patient’s general condition requires intensive monitoring,
with documentation of vital signs, together with daily weight
and abdominal girth measurement. Strict fluid balance
recording is needed, particularly of urine output. Monitoring
trends in the urine output provide important guidelines as to
the accuracy of the fluid balance and resuscitation. A urine
output of < 30 mL/hour implies inadequate perfusion. The
hematocrit is a valuable parameter to evaluate the severity of
hemoconcentration (Orvieto, 2013).
Therapy should remain supportive and conservative aiming at
refilling the arteriolar bed, mobilizing fluid from the third
space, maintaining circulatory hemodynamics, and preventing
hemoconcentration. Treatment of the mild cases is
conservative but severe OHSS requires hospitalization,
correction of fluid, electrolyte and protein imbalance,
prevention of thromboembolism and aspiration of ascistes
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fluid. The main goal of treatment is maintaining circulatory
volume and electrolyte balance. Efforts should be directed
toward restoring a normal intravascular volume and preserving
adequate renal function. This may be achieved by using colloid
plasma expanders or human albumin (Orvieto, 2013).
Albumin has both osmotic and transport functions properties
that underscore its potential for the prevention of OHSS.
Conflicting data are available regarding the potential benefit of
IV albumin at the time of oocyte retrieval to prevent OHSS.
An early review of five randomized clinic trials clearly
showed a benefit associated with the administration of IV
albumin at the time of oocyte retrieval in patients at high risk
of OHSS, with no effect on pregnancy rate. However, a recent
update to this review including eight trails concluded that there
was limited evidence for the benefit of IV albumin in this
setting, although there was no detrimental effect on pregnancy
rate. In contrast, a further systematic review and meta-analysis
of nine trails found that while there was no statistical benefit
regarding the rate of OHSS compared with saline/no fluids, IV
albumin significantly reduced pregnancy rates (Youssef et al.,
2011).
Hydroxyethyl starch (HES) is a plasma expander and a
possible alternative to albumin in this setting. The review of
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studies in three trails using IV albumin also analyzed the
effects of HES at the time of oocyte retrieval in patients at high
risk of OHSS. HES were associated with a significant
reduction in the incidence of OHSS without affecting
pregnancy rates (Youssef et al., 2011).
Albumin administration improves organ function in
critically ill hypoalbuminemic patients
There were 100 patients randomized in prospective controlled
study to receive 300 mL of 20% albumin solution on the first
day then 200 mL/day provided their serum albumin
concentration was <3.1 g/dL (albumin group) or to receive no
albumin (control group). The primary outcome was the effect
of albumin administration on organ function as assessed by
Sequential Organ Failure Assessment score (SOFA) (table 10)
from day 1 to day 7 (or the day of intensive care discharge or
death, whichever came first). The two groups of 50 patients
were comparable at baseline for age, gender, albumin
concentration, and Acute Physiology and Chronic Health
Evaluation II score (APCHE II). Albumin concentration did
not change over time in the control group but increased
consistently in the albumin group. Organ function improved
more in the albumin than in the control group mainly due to a
difference in respiratory, cardiovascular, and central nervous
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110
system components of the SOFA score. Diuretic use was
identical in both groups, but mean fluid gain was almost three
times higher in the control group. Median daily caloric intake
was higher in the albumin than in the control group. So that
albumin administration may improve organ function in
hypoalbuminemic critically ill patients. It results in a less
positive fluid balance and a better tolerance to enteral feeding
(Dubois et al., 2006).
Table (10): Sequential Organ Failure Assessment score
nervous system
SaO2 peripheral arterial oxygen saturation. aPaO2/FIO2 ratio was used preferentially. If not available, the SaO2/FIO2 ratio was used mediations administered for at least 1 hr (dopamine and norepinephrine ug/kg/min).
(Dubois et al., 2006).
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Summary
Albumin is the main protein in human blood and the key to the
regulation of the osmotic pressure of blood. It is a hydrophilic
and non-glycosylated protein. The reference range for albumin
concentrations in blood is 3.4 to 5.4g/dL. The liver is the
primary site of albumin synthesis and during times of
increased albumin loss, the liver can increase the rate of
synthesis, at times nearly tripling the rate of baseline albumin
production.
Albumin is a multifunctional protein with both colloidal and
pharmacological activity. Its colloidal activity is essential in
maintaining fluid balance between the intravascular and
interstitial compartments, because it is the predominant plasma
protein. In addition, albumin is endowed with diverse
biologically specific capabilities such as ligand binding,
antioxidant, free radical-scavenging, anti-inflammatory
activity and inhibition of apoptosis and cell signaling.
On the basis of clinical evidence, the use of albumin in
critically ill patients is based on two theoretical arguments.
First, it contributes to plasma colloid osmotic pressure.
Second, serum albumin levels act as good indicator of the
general health of a person and his clinical status; Lower serum
albumin levels indicate worse severity. There are some widely
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112
shared and fully agreed indications for the appropriate use of
human albumin and indications that are occasionally
appropriate, that is, when other criteria are fulfilled.
Hypovolemia is one of the most common and potentially
reversible crises in acute medicine. In the setting of intensive
care, there is the initial challenge of shock and resuscitation
but there is also often an overlooked challenge of maintaining
euvolemia over the days. An ideal fluid for critically ill
patients should exert a predictable and high-volume effect,
have a balanced, buffered carrier solution and a
pharmacokinetic profile with minimal extravasation and tissue
storage, as well as rapid clearance. Albumin is less to make
peripheral edema and volume needed than crystalloid but no
difference in mortality risk.
FDA has concluded that starch solutions should not be used in
critically ill adult patients including patients with sepsis and
those admitted to the ICU as they increase the risk of mortality
and severe renal injury.
New fluid resuscitation recommendations, weakly
recommended adding albumin to initial fluid resuscitation with
crystalloid for severe sepsis and septic shock (Grade 2B)
despite its antioxidant effects.
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Albumin has several uses in chronic liver diseases, it is used in
prevention of post-paracentesis circulatory dysfunction
(PPCD).
In hepatorenal syndrome, Albumin administration appears
necessary to improve the efficacy of the vasoconstrictor,
terlipressin, as the rate of HRS reversal is significantly lower
with terlipressin alone compared to combination therapy.
Albumin is also used in prevention of hepatorenal syndrome
after spontaneous bacterial peritonitis.
Albumin has several other uses; it can be used in burns,
trauma, renal diseases, after plasmapharesis and in ovarian
hyperstimulation syndrome.
When treating patients with hypoalbuminemia, efforts must be
centered on correction of the underlying disorder rather than
reversal of hypoalbuminemia.
Albumin administration may improve organ function in
hypoalbuminemic critically ill patients. It results in a less
positive fluid balance and a better tolerance to enteral feeding.