albumin, human (normal serum albumin, human)
Albuminar-5, Albuminar-25, Albutein 5%, Albutein 25%, Buminate 5%, Buminate 25%, Plasbumin-5, Plasbumin-25

Available forms
Available by prescription only
Injection: 5% (50 mg/ml) in 50-ml, 250-ml, 500-ml, 1,000-ml vials; 25% (250 mg/ml) in 20-ml, 50-ml, 100-ml vials

Indications and dosages
 Shock. Adults: Initially, 500 ml (5% solution) by I.V. infusion, may repeat after 30 minutes. Dosage varies with patient’s condition and response. Don’t exceed 250 g in 48 hours.
Children: 10 to 20 ml/kg (5% solution) by I.V. infusion, at a rate up to 5 to 10 ml/minute.
 Hypoproteinemia. Adults: 1,000 to 1,500 ml 5% solution by I.V. infusion daily, maximum rate 5 to 10 ml/minute. Or, 200 to 300 ml of 25% solution by I.V. infusion daily, maximum rate 3 ml/minute. Dosage varies with patient’s condition and response.
 Burns. Adults and children: Dosage varies based on extent of burn and patient’s condition. Usually maintain plasma albumin level at 2 to 3 g/dl.
 Hyperbilirubinemia. ◇ Infants: 1 g/kg albumin (4 ml/kg of 25% solution) by I.V. infusion 1 to 2 hours before transfusion.
High-risk neonates with low serum protein levels: 1.4 to 1.8 ml/kg by I.V. infusion of 25% solution.

Pharmacodynamics
Plasma volume-expanding action: Albumin 5% supplies colloid to the blood and expands plasma volume. Albumin 25% provides intravascular oncotic pressure at 5:1, causing fluid to shift from interstitial space to circulation and slightly increasing plasma protein level.

Pharmacokinetics
Absorption: Administered I.V.
Distribution: Accounts for about 50% of plasma proteins; distributed into the intravascular space and extravascular sites, including skin, muscle, and lungs. In patients with reduced circulating blood volume, hemodilution secondary to albumin administration persists for many hours; in patients with normal blood volume, excess fluid and protein are lost.
Metabolism: Although synthesized in the liver, liver isn’t involved in clearance of albumin from plasma in healthy individuals.
Excretion: Little is known about excretion in healthy people. Administration of albumin decreases hepatic albumin synthesis and increases albumin clearance if plasma oncotic pressure is high. In certain pathologic states, the liver, kidneys, or intestines may provide elimination mechanisms for albumin.

Contraindications and precautions
Contraindicated in patients hypersensitive to drug. Use with extreme caution in patients with hypertension, cardiac disease, severe pulmonary infection, severe chronic anemia, or hypoalbuminemia with peripheral edema.

Interactions
Drug-drug. ACE inhibitors: Cause atypical reactions when used with plasma exchange of large volumes of albumin. Withhold ACE inhibitors for 24 hours before plasma exchange.

Adverse reactions
CNS: headache, fever.
CV: hypotension, tachycardia, vascular overload after rapid infusion.
GI: increased salivation, nausea, vomiting.
Musculoskeletal: back pain.
Respiratory: altered respiration, dyspnea, pulmonary edema.
Skin: urticaria, rash.
Other: chills.

Effects on lab test results
• May increase albumin and alkaline phosphatase levels.

Overdose and treatment
Overdose may cause signs of circulatory overload (such as increased venous pressure and distended neck veins) or pulmonary edema.
 Slow flow to a keep-vein-open rate and reevaluate therapy.

Special considerations
• Be certain patient is properly hydrated before starting infusion; product may be administered without regard to blood typing and crossmatching.
• Solution should be a clear amber color; don’t use if cloudy or contains sediment. Store at room temperature; freezing may break bottle.
• Use opened solution promptly, discarding unused portion after 4 hours; solution contains no preservatives and becomes unstable.
• One volume of 25% albumin produces the same hemodilution and relative anemia as five volumes of 5% albumin; reference to "1 unit" albumin usually indicates 50 ml of the 25% concentration containing 12.5 g of albumin.
• Dilute if necessary with normal saline solution or D₅W. Use 5-micron or larger filter; don’t give through 0.22-micron I.V. filter.
• Avoid rapid I.V. infusion; rate is individualized based on patient’s age, condition, and diagnosis. In patients with hypovolemic shock, infuse 5% solution at no more than 2 to 4 ml/minute, and 25% solution (diluted or undiluted) at no more than 1 ml/minute. In patients with normal blood volume, infuse 5% solution at no more than 5 to 10 ml/minute, and 25% solution (diluted or undiluted) at no more than 2 to 3 ml/minute. Don’t give more than 250 g in 48 hours.
• Each liter contains 130 to 160 mEq of sodium before dilution with any additional I.V. fluids; a 50-ml bottle of solution contains 7 to 8 mEq sodium. This preparation was once known as salt-poor albumin.
• Monitor vital signs carefully and observe patient for adverse reactions.
• Monitor intake and output, hematocrit, and hemoglobin, serum protein, and electrolyte levels to help determine continuing dosage.
• The goal is to maintain plasma albumin levels at 2 to 3 g/dl or an oncotic pressure of 20 (total serum protein level of 5.2 g/dl).
Pediatric patients
• Premature infants with low serum protein levels may receive 1.4 to 1.8 ml/kg of a 25% albumin solution/kg by I.V. infusion (350 to 450 mg albumin).

Patient education
• Explain use and administration of albumin to patient and family.
• Tell patient to report adverse effects promptly.

Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE THREATENING.
◆ Canada only
◇ Unlabeled clinical use