Albumin Dosing for Paracentesis

Dosing Guidelines by Procedure Type

The American Association for the Study of Liver Diseases recommends administering 8g albumin per liter of ascites removed for patients undergoing large-volume paracentesis (>5L) 1, 2, 4
The European Association for the Study of the Liver suggests using 20% or 25% albumin solution for large-volume paracentesis (>5L) 1, 3
Albumin replacement is generally not required for small-volume paracentesis (<5L), but may be considered in high-risk patients 1, 3

The American College of Gastroenterology states that albumin prevents post-paracentesis circulatory dysfunction (PICD), which can lead to renal impairment and hepatorenal syndrome 3
Albumin decreases the incidence of hyponatremia compared to alternative plasma expanders (OR=0.61, 95% CI 0.40 to 0.93) 4
The European Respiratory Society notes that albumin is superior to other volume expanders for prevention of paracentesis-induced circulatory dysfunction 5, 6
Albumin reduces the risk of renal dysfunction after large-volume paracentesis 1, 2

The Infectious Diseases Society of America recommends a different dosing regimen for SBP patients: 1.5g albumin/kg within 6 hours of diagnosis, followed by 1g/kg on day 3 1, 2, 7
This dosing reduces the risk of renal dysfunction by 72% and mortality by 47% in SBP patients 2, 7

Despite cost concerns, albumin remains the preferred plasma expander for paracentesis due to superior outcomes 1, 4
Two small RCTs compared standard dose (6-8g/L) with low-dose albumin (2-4g/L) and found no difference in post-paracentesis circulatory dysfunction 1, 4