We believe that there is no role for routine use of albumin in the critically ill patient. Some of the functions of albumin include the following: transport; volume expansion and maintenance of colloid oncotic pressure; and scavenging of free radicals. Unlike synthetic colloids albumin binds reversibly with drugs, hormones, bilirubin and metal ions, among other substances, and so affects their metabolism in the critically ill patient with hypoalbuminaemia [ 6 , 7 ].
Calcium also binds to albumin. Administration of albumin has been shown to result in a decrease in ionic calcium, which could result in myocardial depression [ 8 ]. In the intact vascular compartment, HAS has, in common with other colloids, the potential to produce significant volume expansion and has a half-life of 16 h.
In disease the serum concentration of albumin correlates poorly with colloid oncotic pressure [ 12 ]. The concentration of albumin decreases, often dramatically, from early in the course of a critical illness. It does not increase again until the recovery phase of the illness. We retrospectively studied the changes in serum albumin and oncotic pressure between survivors and nonsurvivors of prolonged critical illness [ 13 ]. The oncotic pressure varied little between or within either group of patients.
There was no relationship between death and oncotic pressure. Albumin has been shown [ 14 ] to be scavenger of free radicals, but this function has not been shown to be of relevance in clinical studies in humans with critical illness. Hypoalbuminaemia reflects morbidity, and predicts mortality and duration of intensive care unit stay in critically ill patients [ 1 ].
Increasing a low serum concentration of albumin, however, does not change the morbidity or mortality in the critically ill [ 5 ]. Hypoalbuminaemia may result from the following: transcapillary leak; decreased synthesis; large volume body fluid losses; and dilution due to fluid resuscitation. The use of albumin for the treatment of hypovolaemia is centred around the argument that albumin will remain in the intravascular space. In the critically ill there is often an inflammatory response that results in capillary leakage and loss of protein including albumin , inflammatory cells and large volumes of fluid into the interstitial space.
The increased vascular permeability is a major cause of hypoalbuminaemia in disease and injury [ 15 , 16 , 17 ]. In a healthy adult albumin is drained by the lymphatics.
In illness albumin in the interstitium draws fluid into this space, impairing re-expansion of the intravascular space and increasing tissue oedema [ 18 ]. This could result in tissue hypoxia, which may be a contributory cause of multiorgan failure [ 19 , 20 ]. In critically ill patients hypoalbuminaemia is a reflection of the severity of the underlying disease.
The rate of albumin synthesis is also significantly decreased in the critically ill. The acute-phase response to trauma, inflammation or sepsis results in an increase in the gene transcription rates for the positive acute-phase proteins such as C-reactive protein, and a decrease in the rates of albumin mRNA transcription and thus synthesis [ 21 , 22 ].
A sustained inflammatory response in critical illness may lead to prolonged inhibition of albumin synthesis. Inflammation, induced by turpentine, in rats decreased the albumin mRNA concentration and synthetic rate, which reached a minimum by about 36 h and then began to increase again [ 25 , 26 ]. There are some healthy humans who are analbuminaemic essentially total lack of albumin. They have a surprising paucity of symptoms, possibly because increases in other constituents of plasma such as globulins and lipids counter the lack of albumin.
The half-life of the small amount of albumin present increases from 19 days to between 38 and days [ 9 ]. There are several potential problems associated with the administration of this substance, and these are discussed below.
The use of any blood product is potentially harmful. Although HAS is pasteurized to reduce the risk of infection, human immunodeficiency virus contamination of a pooled source can be missed at the time of screening. This is because of the window period of seroconversion in donors who have these diseases. It has been suggested [ 27 , 28 , 29 ] that estimates of the risk of plasma being sourced from such a pool within the USA vary from one in five pools for hepatitis B virus, to one in 39 for human immunodeficiency virus, although this risk is being reduced with improved testing.
This change in source of albumin occurred after the suspicion that UK blood products are potentially contaminated with prion proteins. Biological products are not pure. They contain constituents other than what is on the label. Albumin solution is allowed to be green because of its bilirubin content. There are large differences in the quality of albumin preparations. Albumin continues to be used in hypovolaemia by its proponents.
One advantage of hypertonic albumin is said to be its ability to increase the intravascular volume by drawing in interstitial fluid from the extravascular compartment. This is limited, however, because in most critically ill patients there is an increased capillary leakage and extravasation of albumin into the interstitium [ 15 , 16 , 17 ].
For volume therapy in critically ill patients, no benefit over other colloidal therapies has been shown. Stockwell et al [ 32 ] examined critically ill patients who were randomly allocated to receive either 4.
There was no difference between the groups in the incidence of pulmonary oedema or acute renal failure. That study showed no benefit in outcome for patients treated with albumin. With rapid administration of albumin there is up to a fourfold increase in volume retention, which can result in fluid overload, especially pulmonary oedema. Maintenance of the plasma oncotic pressure by albumin blunts the natriuretic response to sodium loading.
Infusion of albumin also results in water and sodium retention, which is described below. An increase in extravascular lung water is seen after lung contusion, sepsis and cardiac failure.
The pulmonary lymphatics have a limited ability to remove large volumes of fluid from the interstitium, making it more vulnerable to oedema than other tissues. Evidence [ 33 ] suggests that the pulmonary dysfunction in critically ill, septic patients is independent of colloid osmotic pressure. Change in pulmonary capillary permeability is thought to be the primary determinant of interstitial fluid accumulation in the lung after trauma [ 8 ].
Leaking of albumin into the interstitium increases the colloid oncotic pressure in this space, and may worsen conditions, such as acute respiratory distress syndrome.
The detrimental effects of albumin on the lung may be related to several factors, including hypervolaemia secondary to antinatriuresis and antidiuresis, and reversed oncotic pressure secondary to increased extravascular pulmonary albumin. Albumin binds to many of these substances, including hormones and some drugs, to help them travel through the body.
So when albumin levels are low, the blood may not be able to transport essential materials effectively. Less frequently, people can develop hypoalbuminemia as a result of a serious burn, a blood infection called sepsis , allergic reactions, lupus , hypothyroidism , or diabetes.
While a doctor tries to find out the reason for hypoalbuminemia and start treatment, some strategies can reduce the risk of serious complications. Some people may need medications to raise their albumin levels. This can include albumin administered via an intravenous needle. The best option for treating hypoalbuminemia is to address the underlying cause.
So people may need to have a variety of tests to determine why there is not enough albumin in their blood. People experiencing hypoalbuminemia due to organ failure may need an organ transplant. People with kidney disease may need dialysis as they await a kidney transplant.
People with hypoalbuminemia may need to be hospitalized and monitored until the condition is corrected. A person may experience a wide range of symptoms, such as confusion, dizziness, and low energy if they are malnourished, for example. It is impossible to diagnose low albumin by some of the symptoms alone, and many symptoms associated with low albumin are also linked to other conditions.
Albumin is present in many animal products. These include:. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your healthcare professional if you are taking any other prescription or nonprescription over-the-counter [OTC] medicine. Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur.
Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco. The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:. A nurse or other trained health professional will give you this medicine in a medical facility. It is given as a needle placed into one of your veins.
It is very important that your doctor check your or your child's progress closely while receiving the medicine to make sure it is working properly. Blood and urine tests are needed to check for unwanted effects.
This medicine may cause a serious allergic reaction, called anaphylaxis, which can be life-threatening and requires immediate medical attention. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated. Updated visitor guidelines. You are here Home » albumin human. Top of the page. What is the most important information I should know about albumin? What is albumin?
Albumin may also be used for purposes not listed in this medication guide. What should I discuss with my healthcare provider before receiving albumin? You should not use albumin if you are allergic to it, or if you have:. It is not known whether albumin will harm an unborn baby.
Tell your doctor if you are pregnant. How is albumin given? What happens if I miss a dose? Because you will receive albumin in a clinical setting, you are not likely to miss a dose. What happens if I overdose?
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