Albumin Infusion Protocol

Primary Treatment Approach for Hypoalbuminemia

The American College of Chest Physicians recommends treating the underlying cause of hypoalbuminemia rather than the low albumin level itself, as hypoalbuminemia reflects inflammation, malnutrition, or protein loss—not a primary albumin deficiency 1, 2
Provide adequate nutritional support with protein intake of 1.2-1.3 g/kg body weight/day, especially in malnourished patients 2, 3

Administer 8 g albumin per liter of ascites removed when removing >5 liters to prevent paracentesis-induced circulatory dysfunction, a conditional recommendation with moderate certainty of evidence 1, 2, 3, 4
Personalize dosing based on baseline creatinine, volume removed, and history of hypotensive symptoms after prior procedures 4, 5
For Spontaneous Bacterial Peritonitis (SBP), use a standard dosing protocol: 1.5 g/kg on day 1 and 1.0 g/kg on day 3, a conditional recommendation with moderate certainty of evidence 1, 5, 6
Consider selective use for high-risk SBP patients (serum bilirubin >4 mg/dL OR serum creatinine >1 mg/dL) rather than all SBP patients 1, 6
Carefully assess volume status, cardiovascular status, and kidney impairment before each infusion and modify dose/frequency accordingly 1, 6

Do NOT administer albumin to hospitalized patients with decompensated cirrhosis targeting albumin >30 g/L—a large RCT showed no improvement in infections, kidney dysfunction, or death, with concern for increased adverse events 1, 4, 6
Do NOT use albumin for first-line volume replacement or to increase serum albumin levels in critically ill adults (excluding thermal injuries and ARDS) 2, 3
Do NOT use weekly or biweekly albumin infusions for nonhospitalized cirrhosis patients with persistent ascites—evidence is conflicting and insufficient 1, 5, 6

For Hypovolemic Shock, administer 25% albumin (Plasbumin-25) intravenously, with a total dose not exceeding 2 g/kg body weight in the absence of active bleeding 2, 5
For Burns (after 24 hours), target plasma albumin concentration of 2.5 ± 0.5 g/100 mL and use 25% albumin for optimal effect 2, 3
For Hypoproteinemia, adults: 50-75 g daily, children: 25 g daily, with a rate restriction not to exceed 2 mL/minute to prevent circulatory embarrassment and pulmonary edema 2

Monitor for fluid overload, hypotension, hemodilution requiring RBC transfusion, anaphylaxis, and peripheral gangrene from dilution of natural anticoagulants 2, 3, 5

For Dialysis Patients, target predialysis albumin ≥4.0 g/dL, focus on adequate nutrition, adequate dialysis clearance, and treating inflammation, and monitor normalized protein nitrogen appearance (nPNA) with target ≥0.9 g/kg/day 2
For Surgical Patients, preoperative albumin <3.0 g/dL increases surgical complications, optimize nutrition preoperatively rather than administering albumin, and correct nutritional deficiency when feasible before cardiac surgery 2