Albumin infusion is indicated in various clinical scenarios, particularly in the management of liver cirrhosis and its complications, as well as in certain critical care settings.
Liver cirrhosis and its complications
- Ascites: Albumin infusion is recommended during large-volume paracentesis (> 5 L) to prevent paracentesis-induced circulatory dysfunction . It is also considered in patients with acute-on-chronic liver failure or high risk of post-paracentesis acute kidney injury (AKI) after paracentesis of < 5 L
- Spontaneous bacterial peritonitis (SBP): Albumin is recommended in patients with SBP and increased or rising serum creatinine to prevent AKI
- Hepatorenal syndrome: Albumin is recommended in the management of hepatorenal syndrome, with doses titrated based on central blood volume measurements to prevent circulatory overload
- Hyponatremia: Albumin infusion is advised in the management of patients with severe hyponatremia (< 120 mEq/L) . It is also considered in patients with hypervolemic hyponatremia
Critical care settings
- Hypoalbuminemia in critically ill patients: Albumin administration may improve organ function in hypoalbuminemic critically ill patients
- Intradialytic hypotension: Albumin infusion before dialysis results in fewer episodes of hypotension and improves fluid removal in hypoalbuminemic patients requiring hemodialysis
- Sepsis-related peripheral tissue hypoperfusion: Albumin infusion might lead to greater improvement of tissue hypoperfusion compared to saline in patients with resuscitated sepsis
Other indications
- Severe muscle cramps: Albumin infusion is considered in patients with severe muscle cramps
- Preterm infants: Albumin infusion is not recommended for volume replacement in preterm infants (< 32 weeks or < 1,500 g) with or without hypoperfusion
In conclusion, albumin infusion is indicated in a variety of clinical scenarios, particularly in the management of liver cirrhosis and its complications, as well as in certain critical care settings. However, the use of albumin should be carefully considered in the context of each patient's specific clinical situation, and the potential benefits should be weighed against the risks, such as volume overload