Albumin (Human) 5% & 25%

• Core dose: 5% albumin 250–500 mL IV over 30–60 min for volume expansion; 25% albumin 50–100 mL IV for hyperoncotic effect (e.g., large-volume paracentesis: 6–8 g per liter removed)
• Onset/duration: Immediate intravascular volume expansion; circulatory half-life ~16–18 hours; whole-body half-life ~15–21 days
• Key danger: Fluid overload and pulmonary edema (especially with 25%); does not contain coagulation factors (not a substitute for plasma); expensive compared to crystalloids
• Special: 5% is iso-oncotic (~1:1 plasma expansion); 25% is hyperoncotic (may expand volume 3–5× infused); indicated for liver disease complications, large-volume paracentesis, septic shock after substantial crystalloids

• Generic Name: Albumin (Human) — plasma-derived colloid
• Brand Names: FLEXBUMIN®, ALBUMINEX®, Albuminar®, Octapharma Albumin® (various 5% and 25% concentrations)

Natural colloid plasma expander; oncotic agent

Mechanism of Action:

• Human albumin supplies colloid oncotic pressure (~25–33 mmHg in plasma), expanding intravascular volume
• 5% is iso-oncotic (≈1:1 plasma volume expansion)
• 25% is hyperoncotic and may expand plasma volume ~3–5× the volume infused if intravascularly depleted
• Albumin also serves as a carrier for endogenous/exogenous substances
• Buffers acid-base via weak-charge effects

Pharmacokinetics/Disposition:

• Distribution: ~30–40% of total body albumin resides intravascularly at steady state
• Transcapillary escape rate: ≈5%/h (higher in sepsis/surgery)
• Circulatory half-life: ≈16–18 h
• Whole-body half-life: ~15–21 days
• Metabolism: Hepatic catabolism by endocytosis/lysosomes
• Elimination: Minimal renal excretion unless proteinuric states

• Acute volume expansion when a colloid is appropriate (e.g., shock/hypovolemia where crystalloids alone are inadequate)
• Sepsis/septic shock: may be considered after substantial crystalloid volumes (adjunct to balanced crystalloids)
• Liver disease complications:
  • Large-volume paracentesis (>5 L)
  • Spontaneous bacterial peritonitis (SBP)
  • Hepatorenal syndrome (with vasoconstrictor)
• Plasma exchange replacement fluid
• Perioperative volume support (institutional)
• Burn resuscitation (typically after first 12–24 h in select protocols)

• Hypovolemic shock
• Septic shock (adjunct after crystalloids)
• Cirrhosis with complications (ascites, SBP, hepatorenal syndrome)
• Burns (select protocols)
• Hypoalbuminemia (adjunct; not for nutritional replacement)

Available Forms:

• 5% and 25% albumin in 50–250 mL vials/bottles
• Examples: 50 mL/100 mL vials (12.5 g & 25 g for 25%); several sizes for 5%
• Use vented IV set
• Warning: Do not dilute with sterile water (risk of hemolysis)

Adult Dosing - Hypovolemia/Shock:

• 5% albumin 10–20 mL/kg (≈0.5–1 g/kg) IV; titrate to perfusion
• May infuse faster in overt shock with close monitoring

Adult Dosing - Hypoalbuminemia (Adjunct):

• 25% albumin 0.5–1 g/kg IV in divided doses as clinically indicated
• Note: Not for nutritional replacement

Adult Dosing - Sepsis/Septic Shock (Adjunct):

• After initial crystalloids (e.g., 30 mL/kg), consider daily 20%/25% albumin to target serum albumin ≥3 g/dL per institutional protocol

Adult Dosing - Liver Disease Complications:

• Large-volume paracentesis (LVP): 6–8 g albumin per liter of ascites removed when >5 L removed (use 20–25% solution)
• SBP (with antibiotics): 1.5 g/kg within 6 h of diagnosis + 1.0 g/kg on day 3 (20–25% solution)
• Hepatorenal syndrome (with vasoconstrictor): 1 g/kg (max 100 g) day 1, then 20–40 g/day thereafter (20–25% solution)

Pediatric Dosing:

• General: 5% albumin 10–20 mL/kg (≈0.5–1 g/kg) for shock/hypovolemia
• Neonatal use requires caution and slower rates
• Pediatric liver dosing generally parallels adult weight-based protocols (SBP/HRS per specialist guidance)

Contraindications:

• Hypersensitivity to human albumin or excipients (e.g., caprylate, N-acetyl-DL-tryptophanate)
• Severe anemia
• Decompensated heart failure with normal/raised intravascular volume (risk of acute pulmonary edema)

Precautions:

• Use with caution in renal failure, cirrhosis with risk of volume overload
• Use with caution in conditions with non-osmotic AVP release (hyponatremia risk)
• Do not use as a nutritional protein source

Infusion Reactions:

• Urticaria, flushing, fever
• Anaphylactoid reactions

Volume-Related:

• Hypervolemia/pulmonary edema
• Hemodilution
• Hypertension

Hematologic:

• Dilutional coagulopathy at high doses (relative)

Electrolyte/Metabolic:

• Electrolyte shifts (e.g., sodium load)
• Hypo/hypernatremia depending on context

Other:

• Headache, nausea
• Local infusion site complications

Compatibility:

• Generally compatible with standard electrolyte/carbohydrate solutions (NS, LR, Plasma-Lyte, D5W)
• Avoid mixing with: Protein hydrolysates, amino acid solutions, or solutions containing alcohol
• Do not dilute with sterile water (risk of hemolysis)

Blood Products:

• Albumin is a blood product; follow institutional policy for co-infusion/line priming
• Often NS preferred for RBCs

Y-Site Compatibility:

• Check Y-site compatibility references for specific drugs
• Practice varies by product

Perfusion Endpoints:

• MAP ≥65 mmHg (if shock)
• Mental status, capillary refill
• Lactate trend
• Urine output (≥0.5 mL/kg/h adults; ≥1 mL/kg/h peds)

Respiratory Status:

• SpO₂, work of breathing, chest exam
• Monitor for fluid overload

Laboratory Monitoring:

• Serum albumin
• Electrolytes (Na⁺/Cl⁻)
• ABG/VBG as indicated
• Hemoglobin/hematocrit for hemodilution
• Renal function (SCr, BUN)

Fluid Balance:

• Cumulative fluid balance
• Neurologic status in TBI

5% Albumin:

• 50 g/L human albumin
• Sodium ~130–160 mmol/L
• Stabilizers commonly caprylate and N-acetyl-DL-tryptophanate
• pH ~6.4–7.4

25% Albumin:

• 250 g/L human albumin
• Sodium typically ~130–160 mmol/L
• Hyperoncotic formulation
• Low electrolytes relative to 5%

Manufacturing:

• Both are iso-oncotic/hyperoncotic solutions derived from pooled plasma
• Pasteurized
• Extremely low risk of pathogen transmission with modern manufacturing

• 1. Finfer, S., Bellomo, R., Boyce, N., et al.; SAFE Study Investigators. (2004). A comparison of albumin and saline for fluid resuscitation in the ICU. New England Journal of Medicine, 350(22), 2247–2256. https://doi.org/10.1056/NEJMoa040232
• 2. Caironi, P., Tognoni, G., Masson, S., et al.; ALBIOS Study Investigators. (2014). Albumin replacement in patients with severe sepsis or septic shock. New England Journal of Medicine, 370(15), 1412–1421. https://doi.org/10.1056/NEJMoa1305727
• 3. Evans, L., Rhodes, A., Alhazzani, W., et al. (2021). Surviving Sepsis Campaign: 2021 guidelines for management of sepsis and septic shock. Intensive Care Medicine, 47, 1181–1247. https://doi.org/10.1007/s00134-021-06506-y
• 4. Biggins, S. W., Angeli, P., Garcia-Tsao, G., et al. (2021). Diagnosis, evaluation, and management of ascites, SBP, and HRS: AASLD practice guidance. Hepatology, 74(2), 1014–1048. https://doi.org/10.1002/hep.31884
• 5. FDA. (2006–2020). Albumin (Human) 5% and 25% — Prescribing Information (e.g., Albuminex, Albuminar, Flexbumin). U.S. Food & Drug Administration / DailyMed labels.
• 6. Medscape. (2024–2025). Albumin (Human) IV (monograph): dosing, indications, adverse effects.
• 7. Zdolsek, M., et al. (2022). Plasma disappearance rate of albumin when infused as a 20% solution. Scientific Reports, 12, 4715.
• 8. Chahid, Y., et al. (2021). Transcapillary escape rate of 125I-albumin. EJNMMI Radiopharmacy and Chemistry, 6, 7.
• 9. Cooper, D. J., et al. (2013). Albumin resuscitation and increased intracranial pressure in TBI. Critical Care and Resuscitation, 15(4), 277–284.