plasma protein fraction
Plasmanate, Plasma-Plex, Plasmatein, Protenate

Available forms
Available by prescription only
Injection: 5% solution in 50-ml, 250-ml, 500-ml vials

Indications and dosages
 Shock. Adults: Varies with patient’s condition and response, but usually 250 to 500 ml (12.5 to 25 g protein) I.V., not to exceed 10 ml/minute.
Children and infants: 22 to 33 ml/kg I.V. infused at rate of 5 to 10 ml/minute.
 Hypoproteinemia. Adults: 1,000 to 1,500 ml I.V. daily. Maximum infusion rate is 8 ml/minute (500 ml infused in 30 to 45 minutes).

Pharmacodynamics
Plasma-expanding action: Supplies colloid to the blood and expands plasma volume. Causes fluid to shift from interstitial spaces into the circulation and slightly increases the plasma protein level. Composed mostly of albumin, but may contain up to 17% alpha and beta globulins and not more than 1% gamma globulin.

Pharmacokinetics
Absorption: The pharmacokinetics of plasma protein fraction (PPF) are similar to its chief constituent, albumin.
Absorption: Administered I.V.
Distribution: Albumin accounts for about 50% of plasma proteins. Distributed into intravascular space and extravascular sites, including skin, muscle, and lungs. In patients with reduced circulating blood volumes, hemodilution secondary to albumin administration lasts for many hours; in patients with normal blood volume, excess fluid and protein are lost from intravascular space within a few hours.
Metabolism: Albumin synthesized in liver, but liver isn’t involved in clearance of albumin from plasma in healthy individuals.
Excretion: Little is known about albumin excretion in healthy individuals. Administration of albumin decreases hepatic albumin synthesis and increases albumin clearance if plasma oncotic pressure is high. In certain pathologic states, liver, kidneys, or intestines may provide elimination mechanisms.

Contraindications and precautions
Contraindicated in patients with severe anemia or heart failure and in those undergoing cardiac bypass. Use cautiously in patients with impaired renal or hepatic function, low cardiac reserve, or restricted salt intake.

Interactions
None reported.

Adverse reactions
CNS: headache, fever.
CV: hypotension (after rapid infusion or intra-arterial administration), vascular overload, tachycardia.
GI: nausea, vomiting, hypersalivation.
Metabolic: increased plasma protein levels.
Musculoskeletal: back pain.
Respiratory: dyspnea, pulmonary edema.
Skin: rash, flushing.
Other: chills.

Effects on lab test results
None reported.

Overdose and treatment
Rapid infusion can cause circulatory overload and pulmonary edema.
 Watch patient for signs of hypervolemia; monitor blood pressure and central venous pressure. Treatment is symptomatic.

Special considerations
• Don’t use solution if cloudy, contains sediment, or has been frozen. Store at room temperature; freezing may break bottle and allow bacterial contamination.
• Use opened solution promptly, discarding unused portion after 4 hours; solution contains no preservatives and becomes unstable.
• One unit is usually considered to be 250 ml of the 5% concentration.
 ALERT Avoid rapid I.V. infusion. Rate is individualized according to patient’s age, condition, and diagnosis. Maximum dose is 250 g/48 hours; don’t give faster than 10 ml/minute. Decrease infusion rate to 5 to 8 ml/minute as plasma volume approaches normal.
• PPF is also used in treatment of burns; dosage depends on extent and severity of burn.
• No cross-matching is needed. PPF shouldn’t be administered with same administration set of solutions containing protein hydrolysates, amino acid solutions, or alcohol.
• If patient is dehydrated, give additional fluids either P.O. or I.V.
• Each liter contains 130 to 160 mEq of sodium before dilution with any additional I.V. fluids; a 250-ml container of the 5% concentration contains about 33 to 40 mEq sodium.
• Monitor blood pressure frequently; slow or stop infusion if hypotension suddenly occurs. Vital signs should return to normal gradually.
• Observe patient for signs of vascular overload (heart failure, pulmonary edema, widening pulse pressure indicating increased cardiac output) and signs of hemorrhage or shock (after surgery or trauma); be alert for bleeding sites not evident at lower blood pressure.
• Monitor intake and output (watch especially for decreased output), hemoglobin, hematocrit, and serum protein and electrolyte levels to help determine ongoing dosage.
Geriatric patients
• Patients with cardiac or renal insufficiency may be prone to fluid overload with vascular and pulmonary congestion.

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

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