Albumin is the most abundant protein in the blood and accounts for about 50% of all plasma proteins. It gets synthesized by the liver and secreted immediately without storage. The physiological regulators of albumin are the colloid osmotic pressure and nutritional status. The metabolism of albumin depends on the synthesis, distribution over interstitium and intravascular compartment, and excretion. Normal blood plasma concentration is between 3.5 to 5 g/dL, and 60% of the total albumin is in the interstitial space. The mean half-life is about 28 to 36 days.
The chief medical uses are pharmacological therapy, serum marker to monitor diseases, biomaterials, and vaccines.
Spontaneous bacterial peritonitis (SBP) is a significant cause of mortality in cirrhotic patients. Administration of albumin 1.5 g/kg within 6 hours and 1 g/kg on day three along with antibiotics have a better effect in preventing renal impairment and reducing mortality from 29% to 10% in cirrhotic patients with SBP compared to those receiving antibiotics only. Another clinical trial confirmed the benefit of this therapy with laboratory, cardiac, and Doppler parameters. Improvement in portal vein flow volume (p = 0.01) and reduction of inflammatory marker TNFa in ascites (p = 0.04) were reported.
The regular price of intravenous albumin solution is around $0.5 to $6 per milliliter. Compared to saline solutions $0.01 to $0.1 per milliliter, albumin solutions are 60-times more expensive. Price takes place when saline solutions and albumin infusions have the same efficacy in the treatment of a disease.
Albumin has two essential physiologic functions:
The principal mechanism of action of albumin infusion is to increase the colloid osmotic pressure. It drives the interstitial fluid into the intravascular compartment and increases the effective volume of the circulatory system.
The only mode of administration of albumin is by intravenous (IV) infusion. There are two formulations available that differ on the albumin concentration; albumin 5% and 25%. In general terms, albumin 25% is the therapeutic choice when either sodium or fluid is restricted or in cases of oncotic deficiencies. Albumin 5% use is more common in situations of volume loss as dehydration. However, concentration, the rate of infusion, and dosage depend on the clinical situation, as stated above.
Since albumin solution is a human-derived blood product, adverse effects are rare. In less than 0.1%, anaphylactoid reactions, flushing, urticaria, fever, chills, nausea, vomiting, tachycardia, and hypotension can occur. These reactions normally disappear when the infusion rate is slowed or stopped. Edema and fluid overload are common adverse effects, which depend on the volume, speed of the infusion, and the clinical scenario. In very rare cases, anaphylactic shock may occur. (Pharmaceutical prescribing information).
It is recommended to assess fluid overload, hemodilution, and electrolyte disturbances; this is preventable by monitoring: blood pressure, heart rate, central venous pressure, pulmonary artery occlusion pressure, electrolytes, hemoglobin, and hematocrit.
Albumin solution is a derived product from a large pool of human plasma. It goes through a sterilization process, pasteurization, and heating, but it is not completely sterile. However, the risk of infectious disease transmission, viruses, or prions, is remote. It contains no preservatives. Once opened, it must be used immediately, and the unused portion discarded.
Healthcare workers, including nurses, who work in the emergency department or the ICU, need to know about the indications and contraindications for albumin. While the colloid is safe, it may rarely induce an anaphylactoid reaction. Thus, it is crucial to understand how to manage this adverse reaction. With larger doses, albumin infusions can cause fluid overload and electrolyte disturbances.
The clinician will decide to use albumin colloid albumin, but in most cases, the nursing staff will administer it. They can verify administration and dosing with the pharmacy and should understand the adverse reactions mentioned above so they can alert the managing clinician promptly. The pharmacist should also have involvement with checking the patient's administration record so the team can make dose adjustments for protein-bound drugs, if necessary. The interprofessional team methodology is the best means by which patient outcomes can achieve their optimal result when using albumin therapeutically. [Level V]
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