Albumin Replacement Formula for Paracentesis in Ascites

Dosing Guidelines Based on Volume Removed

The American Association for the Study of Liver Diseases recommends albumin replacement at 6-8 g/L of ascites removed for paracentesis of >5 liters, which is strongly recommended for large volume paracentesis or LVP 2, 3, 5
For paracentesis of <5 liters, albumin replacement is generally not required as these smaller volume removals are not associated with significant hemodynamic changes 6
For patients at higher risk, such as those with acute-on-chronic liver failure or high risk of post-paracentesis acute kidney injury, albumin replacement at 8 g/L should be considered even for volumes <5 liters 5

Albumin replacement prevents post-paracentesis circulatory dysfunction (PPCD), which can lead to serious complications including renal impairment and hepatorenal syndrome, dilutional hyponatremia, hepatic encephalopathy, and increased mortality 5, 6, 7

The risk of PPCD increases with >8 L of fluid evacuated in a single session 6
For patients with spontaneous bacterial peritonitis (SBP), a different dosing regimen is recommended: 1.5 g albumin/kg within 6 hours of diagnosis, followed by 1 g/kg on day 3 5, 7

Albumin should be administered as 20% or 25% solution, with 25% albumin solution containing 25 g of albumin per 100 mL 5, 8
Infusion should occur after paracentesis is completed 5