IV Albumin indications, dosage calculation, monitoring & therapeutic regimen according to the administration guideline 18-26/March/2025

1. Severe (acute) Nephrotic Syndrome
Cases of severe refractory edema with anasarca or
pulmonary edema, with the following criteria:
Urinary protein excretion >3 g/day + hypercholesterolemia+
hypoalbuminemia
Loop diuretic resistance (insufficient response to lV bolus dose
of >160 mg furosemide followed by >8hr infusion of >20 mg/hr
furosemide)
Symptoms and signs of sub-acute intravascular volume
depletion, including:
oliguria,, poor peripheral perfusion
abdominal pain, raised creatinine and hematocrit;
always under supervision of consultant pediatric nephrologists
Acute nephrosis /chronic glomerulonephritis +
subsequent Hypoalbuminemia
Short-term use, in conjunction with diuretic therapy,
for pt. with: acute, severe peripheral or pulmonary edema who
have failed diuretic therapy
S. Albumin < 2 g/dl, with marked hypovolemia
and/or acute pulmonary edema and/or acute kidney injury
Plasmapheresis
Based on plasma volume + serum fibrinogen
Diagnosis of suspected hepatorenal syndrome (HRS)
Confirmed hepatorenal syndrome
S. Creatinine>1.5mg/dl in the presence of cirrhosis
Absence of shock, ongoing bacterial infection &/ current tx. With
nephrotoxic drugs
Absence of sustained improvement in RF after diuretics discontinuation
+ trial of albumin 1g/kg
Absence of proteinrea<500mg/day or haematuria <50 RBCs/high power
field
Absence of U/S evidence of obstructive uropathy or parenchymal renal
disease
Spontaneous bacterial peritonitis,
Pt. with ascetic fluid PMN count 250cell/mm3 (0.25*109/l) + one of the
following
S. Creatinine.>1gm/dl
BUN >30mg/dl or Total bilirubin>4mg/dl
Postoperative volume resuscitation after cardiac or major surgery
in the liver or bowel
(post-operative volume expander, as a last choice of treatment after
crystalloids or non-protein colloids)
Major Hepatic Resection (>40% resected)
Pt. with S. Albumin<2.59/dl (if crystalloids alone fail to achieve adequate
intravascular volume)
Large volume paracentesis with Cirrhosis + Refractory
ascites with portal hypertension
Malnutrition syndrome
(diarrhoea associated with enteral feeding intolerance)
significant diarrhoea (>2 L/day)
S. albumin <2.0g/dl
Ascites non responsive to diuretics
S. albumin <2.0g/dl
Burns
Post the resuscitation phase (after 24hr of burn injuries according
to the BSA)
Hyperbilirubinemia of the newborns
Plasma exchange defined with isotonic solutions
Severe hypoalnbuminemia with low palsma volume +
generalized oedema
(when salt & water restriction & plasma volume expansion is
required)
Indication Dosage
Large volume paracentesis 6
-
8 g/L of ascetic fluid removed (20%)
Plasmapheresis Depend on
plasma vol. & S. fibrinogen level
Suspected HRS diagnosis 1g/kg/day for 2days
Max 100g/day
Confirmed HRS 25
-
50 g/day for total of 72hr
Start 1-2day after diagnostic trial of al-
bumin
Used in addition to octreotide
Preoperative vol. resuscita-
tion after cardiac/ major sur-
gery of the liver & bowel
Used if ≥3L crystalloid was
given/24hr peroidwithout adequate he-
modynamic response (5%)
SBP & cirrhosis 1.5g/kg within 6hr – on day1
1g/kg on day3
Major hepatic resection
Post liver transplant
25g/day up to 4days
till S/albumin is ≥2.5g/dL
Severe/acute nephrotic syn-
drome
25g combined with diuretics
Acute nephrosis/chr. Glo-
merular nephritis & subse-
quent hypoalbuminemia
Short term tx.
Combined with diuretics
Albumin
is not approved in case of:
 Albuminemia ≥2.5g/dl
 Hypoalbuminemia without oedema & acute hypotension
 Acute respiratory distress syndrome (ARDS)
 Septic shock
 Hypovolemic, bleeding & haemorrhagic shock
 Non haemorrhagic shock
 Traumatic brain injury
 Cerebral ischemia
 Major trauma
 Wound healing
 Ascites responsive to diuretics
 Abdominal compartment syndrome
 Acute/chronic pancreatitis
 Renal transplant
 Haemodialysis without malnutrition
 Burns in the 1st 24hr
 Post-operative in the immediate period post-op.
 Acute normovolemic hemodilution in surgery
 Malnutrition
 Protein losing enteropathy & malabsorption Ovarian hyperstimulation
syndrome
Albumin dose calculation
Albumin (g)= [desired albumin conc. (2.5g/dL) - actual al-
bumin conc. (g/dL)] * plasma vol. (0.8*BW in kg)
Albumin, Monitoring
Assess dose daily according to pt. condition [adjust fliud
& electrolyte therapy]
Correct dehydration if there is:
 Hx. Of cardiovascular dis.
 Incorrect capillary permeability
 Risk of hemodilution (severe anemia/hemorrhagic dis-
order)
 Risk of hypervolemia (oesophageal varices/pulmonary
edema)
 Vaccination against hepatitis A & B
Discontinue/stop albumin,
when:
 Tx. Is not necessary S. albumin 2-2.5g/dL
 Systolic BP >100mmHg or mean artrial P <60mmHg
 Urine output >0.5ml/kg/hr
 Improved clinical condition
 Improved edema
 Other measures of luid responsiveness
Drug Information Centre
Alaa Fadhel Hassan (MSc. Pharmacology)
Ref. MOH Albumin adm. Guidelines No. 1160