It is considered appropriate to use Albumin in the following conditions:

1. Volume expansion for
:

1. Shock (other than blood loss) when systolic blood pressure is less than 90 mm Hg; central venous pressure or pulmonary capillary wedge pressure are low or when excessive volumes of crystalloids are required to maintain blood pressure. Should be used in conjunction with crystalloids.

2. Shock due to blood loss after a crystalloid solution when estimated blood loss is less than 10 - 15% of total volume.
3. Acute edematous states when the serum albumin is less than 3 g/dL.
4. After the removal or loss of 1.5 L or more of ascitic fluid. Second line agent after crystalloids after removal of 4 liters or more of ascitic fluid

5. After hepatic resection (>40%) depending on function of residual liver - after crystalloid use.
6. Thermal Injury in conjunction with crystalloids if all of the following are true:

• Burns cover greater than 50% of BSA
• Treatment is 24 hours after occurrence of burn
• Crystalloid therapy has failed to correct hypovolumenia
7. Nutritional Intervention in patients with diarrhea associated with enteral feeding if ALL of the following conditions are met:

• Diarrhea greater than 2 liters a day

• Serum albumin is less than 2.0 g/dL.

• Failure of short-chain peptide and elemental formulas

• Other causes of diarrhea have been considered and ruled out (documented)

2. In Surgery:

   • As a priming fluid in pump oxygenators during cardiopulmonary bypass surgery to maintain the patient’s hematocrit at 20% and the serum albumin concentration at 2.5 g/dL. In cases in which it is extremely important to avoid pulmonary interstitial fluid accumulation, nonprotein colloids in addition to crystalloids may be used. For post op volume expansion, albumin is third choice after crystalloids and nonprotein colloids.

3. Should not be used as a source of protein.

4. Hyperbilirubinemia of the Newborn - may be used as an adjuvant to exchange transfusions and only with concurrent transfusion of blood ( Albumin only)

5. Nephrotic Syndrome - short term albumin use, in conjunction with diuretic therapy, for acute, severe peripheral or pulmonary edema.

6. Organ transplantation - In postoperative liver transplant patients in the control of ascites and peripheral edema if ALL of the following conditions are met: 

   • Serum albumin is less than 2.5 g/dl

   • Pulmonary capillary wedge pressure is less than 12 mm Hg.

   • Hematocrit is greater than 30%

7. Plasmapheresis - In large-volume plasma exchange of greater than 20 ml/kg in one session or greater than 20 ml/kg/week in repeated sessions.

8. Severe, necrotizing pancreatitis

RECOMMENDATION

Since there is little discernable difference between indications for Albumin and Hetastarch, the product of choice in most cases unless specifically indicated otherwise, should be determined by which one is less expensive to purchase.