human serum albumin: clinical use

Prescribing considerations

• Base use on demonstrated volume deficiency and haemodynamic assessment rather than plasma albumin concentration alone.
• Ensure adequate hydration with concentrated hyperoncotic albumin and stop administration if cardiovascular overload develops.
• Record the product name and batch number for traceability.
• Evidence in children is limited; explicitly assess benefits and risks.
• Use caution in severe traumatic brain injury because follow-up evidence associated albumin resuscitation with higher mortality than saline.

Contraindications and cautions

• Hypersensitivity to albumin preparations or any excipient.
• Use particular caution where hypervolaemia or haemodilution poses added risk, including decompensated cardiac insufficiency, hypertension, oesophageal varices, pulmonary oedema, haemorrhagic diathesis, severe anaemia, and renal or post-renal anuria.

Monitoring

• Haemodynamic response, including blood pressure, pulse and urine output.
• Fluid status and signs of hypervolaemia or pulmonary oedema.
• Electrolytes, haemoglobin and haematocrit; assess coagulation and replacement of other blood constituents when substantial volume replacement is required.

Clinical pharmacology

Albumin is the principal contributor to plasma oncotic pressure and acts as a carrier protein. Concentrated human albumin is hyperoncotic; its plasma-volume effect varies and may be less predictable when capillary permeability is increased, such as in severe burns or septic shock.

Formulation and product differences

• The selected product is a concentrated, hyperoncotic solution containing sodium; sodium exposure may matter for patients requiring restriction.
• Concentrated albumin contains fewer electrolytes than less-concentrated albumin solutions, making electrolyte monitoring important.
• It may be infused directly or diluted with compatible isotonic glucose or sodium chloride solution. Water for injections is unsuitable because of haemolysis risk.
• Use an opened container immediately. Do not freeze or use cloudy solutions or those containing deposits.

Solution for infusion

Route: Intravenous

Strengths: 50 g/L, 200 g/L, 5%, 20%