Human Albumin Administration Guidelines

Primary Recommendations

The American Association for the Study of Liver Diseases recommends administering 6-8 grams of albumin per liter of ascites removed using 20% or 25% albumin solution, infused after the paracentesis is completed over 1-4 hours for large-volume paracentesis (>5L) 1, 2, 3
The standard dose for large-volume paracentesis is 6-8 g albumin per liter of ascites removed 1, 2, 3

For spontaneous bacterial peritonitis (SBP), administer 1.5 g/kg body weight within 6 hours of diagnosis and 1.0 g/kg body weight on day 3, with the highest benefit in patients with serum bilirubin >4 mg/dL and/or baseline creatinine >1.0 mg/dL with BUN >30 mg/dL, reducing AKI from 33% to 10% and mortality from 29% to 10% 5, 4, 6
For hepatorenal syndrome (HRS-AKI), administer 10-20 grams IV daily for up to 20 days, always in combination with vasoconstrictors (e.g., terlipressin) 4, 5

The American Association for the Study of Liver Diseases prefers 25% albumin when minimizing volume is critical, sodium restriction is required, or volume expansion is needed 4, 6

Infuse 1.5 g/kg dose within 6 hours of diagnosis for SBP 5, 6
Infuse over 1-4 hours post-procedure (approximately 80-320 mL/hour for typical volumes) for post-paracentesis 4

Fluid overload and pulmonary edema are the most significant risks, especially with higher doses or rapid infusion 5, 4, 6

Albumin costs approximately $130 per 25g, making it substantially more expensive than crystalloids, supporting restricting use to well-defined, evidence-based indications where benefit is proven 4, 6