ALBUREL

Indications

• Hypoalbuminemia
• Volume resuscitation in shock
• Liver cirrhosis
• Nephrotic syndrome
• Burns
• Postoperative fluid management

Dosage

Children: Refer to the BNF for Children for specific dosing recommendations based on clinical condition and patient response.

Adults: Refer to the appropriate guidelines for specific dosing recommendations based on clinical condition and patient response.

Mechanism of action

Albumin acts by maintaining oncotic pressure in the vascular system, thus preventing fluid from leaking into tissues and promoting the return of interstitial fluid to the bloodstream. This action helps restore blood volume and improve circulation in patients with conditions that lead to hypovolemia or edema. Additionally, albumin can bind and transport various endogenous and exogenous substances, influencing their distribution and elimination.

Pharmacodynamics

The primary pharmacodynamic effect of albumin is the increase in plasma oncotic pressure, which helps to retain fluid within the vascular space. This effect is critical in managing conditions associated with fluid imbalance. Albumin also has antioxidant properties and may play a role in modulating inflammatory responses, although these effects are secondary to its role in volume expansion.

Pharmacokinetics

Albumin is administered intravenously, where it is distributed rapidly throughout the vascular compartment. The half-life of albumin in circulation is typically around 15 to 20 days, depending on physiological conditions. It is metabolized primarily in the liver, with a small percentage undergoing renal clearance. The distribution volume is influenced by factors such as hydration status and the presence of diseases affecting protein levels.

Contra-indications

• Severe anemia
• Congestive heart failure
• Pulmonary edema
• Severe dehydration
• Allergy to albumin or any component of the formulation

Adverse effects

• Allergic reactions including anaphylaxis
• Headache
• Nausea
• Vomiting
• Fever
• Hypotension
• Fluid overload

Interactions

• Caution should be exercised when administering with other fluids or medications that may affect fluid balance
• May alter the pharmacokinetics of certain drugs due to changes in plasma volume

Precautions

• Monitor for signs of fluid overload, especially in patients with heart or kidney disease
• Use cautiously in patients with a history of allergic reactions
• Ensure proper storage and handling to avoid contamination

Pregnancy

Albumin is generally considered safe during pregnancy when administered for appropriate indications, but its use should be assessed on a case-by-case basis.

Breast-feeding

Albumin can be used during breastfeeding, as it is a naturally occurring protein in human milk.

Storage

Store at 2 to 8 degrees Celsius. Do not freeze. Protect from light and use within the expiry date.

Formulations

• Human albumin solution (various concentrations)
• Albumin (500 mL bags, 20% and 5% solutions)