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Albumin Calculator (Adult dosing)

Indications covered

   1,2,3,4
 Weight:
Note: Albumin 5% solutions are iso-oncotic with human plasma and increase the plasma volume by the volume that is infused.  However, albumin 25% causes the plasma volume to expand by 3.5 times the volume that is infused.

Background Info   top of page

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Albumin (25%)
: 3,4
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CLINICAL PHARMACOLOGY
Albuminar®-25 is active osmotically and is therefore important in regulating the volume of circulating blood. When injected intravenously, 50 mL of 25% albumin draws approximately 175 mL of additional fluid into the circulation within 15 minutes, except in the presence of marked dehydration. This extra fluid reduces hemoconcentration and blood viscosity. The degree of volume expansion is dependent on the initial blood volume. When the circulating blood volume has been depleted, the hemodilution following albumin administration persists for many hours. In individuals with normal blood volume, it usually lasts only a few hours.

Albumin, unlike whole blood or plasma, is considered free of the danger of homologous serum hepatitis. Albuminar®-25 may be given in conjunction with other parenteral fluids such as saline, dextrose or sodium lactate. It is convenient to use since no cross-matching is required and the absence of cellular elements removes the danger of sensitization with repeated infusions.

INDICATIONS AND USAGE
Hypovolemia
ALBUMIN (HUMAN) 25% is indicated in the emergency treatment of hypovolemia with or without shock. Its effectiveness in reversing hypovolemia depends largely upon its ability to draw interstitial fluid into the circulation. It is most effective in patients who are well hydrated. When blood volume deficit is the result of hemorrhage, compatible red blood cells or whole blood should be administered as quickly as possible.

When hypovolemia is long standing and hypoalbuminemia exists accompanied by adequate hydration or edema, 20% - 25% albumin solutions should be used.

Hypoalbuminemia
For subjects with hypoalbuminemia who are critically ill and/or are bleeding actively, ALBUMIN (HUMAN) 25% infusions may be indicated. When albumin deficit is the result of excessive protein loss, the effect of administration of ALBUMIN (HUMAN) 25% will be temporary unless the underlying disorder is reversed.

Prevention of Central Volume Depletion after Paracentesis due to Cirrhotic Ascites (Treatment Adjunct)
ALBUMIN (HUMAN) 25% may be used to maintain cardiovascular function following the removal of large volumes of ascitic fluid after paracentesis due to cirrhotic ascites.

Ovarian Hyperstimulation Syndrome (OHSS)
ALBUMIN (HUMAN) 25% may be used as a plasma expander in fluid management relating to severe forms of ovarian hyperstimulation syndrome (OHSS).

Adult Respiratory Distress Syndrome (ARDS) (Treatment Adjunct)
ALBUMIN (HUMAN) 25% infusions may be indicated in conjunction with diuretics to correct the fluid volume overload associated with ARDS.

Acute Nephrosis (Treatment Adjunct)
ALBUMIN (HUMAN) 25% may be used to treat edema in patients with acute nephrosis who are refractory to cyclophosphamide and corticosteroid therapy.

Hemolytic Disease of the Newborn (HDN)
ALBUMIN (HUMAN) 25% is indicated in the treatment of hyperbilirubinemia. It may be used prior to or during an exchange procedure in an attempt to bind free bilirubin and to enhance its removal.

CONTRAINDICATIONS
Albuminar®-25 may be contraindicated in patients with severe anemia or cardiac failure and in patients with a history of allergic reactions to human albumin.

WARNINGS
Infusion of protein-containing solutions such as Albuminar®-25 that have been excessively or inappropriately diluted with hypotonic solutions such as sterile water for injection may result in severe hemolysis and acute renal failure. Please refer to the DOSAGE AND ADMINISTRATION section for information about the recommended diluents for Albuminar®-25, which are normal saline and 5% dextrose.

Do not use if the solution is turbid. Since this product contains no antimicrobial preservative, do not begin administration more than 4 hours after the container has been entered.

WARNINGS AND PRECAUTIONS
•Hypersensitivity or allergic reactions have been observed, and may in some cases progress to severe anaphylaxis. Epinephrine should be available immediately to treat any acute hypersensitivity reaction.

•Hypervolemia: Use with caution in patients who are at risk of hypervolemia or hemodilution. Stop infusion if signs of cardiovascular overload occur.

•Electrolyte imbalances have been observed. Monitor electrolyte status.

•Ensure adequate substitution of other blood constituents. Monitor coagulation status and hematocrit.

•Hypotension has been observed. Monitor hemodynamic performance.

•Do not dilute solution with sterile water for injection.

•This product is made from human plasma and may contain infectious agents, e.g., viruses and, theoretically, the Creutzfeldt-Jakob disease agent.

ADVERSE REACTIONS
The incidence of untoward reactions to Albuminar®-25 is low. Reports have been received of anaphylaxis, which may be severe, and hypersensitivity reactions (including urticaria, skin rash, pruritus, edema, erythema, hypotension and bronchospasm). Nausea, vomiting, increased salivation, chills and febrile reactions have also been reported (see package insert for additional information).

DOSAGE AND ADMINISTRATION
Albuminar®-25 may be given intravenously without dilution or it may be diluted with normal saline or 5% dextrose before administration. 200 mL per liter gives a solution which is approximately isotonic and iso-osmotic with citrated plasma.

When undiluted albumin solution is administered in patients with normal blood volume, the rate of infusion should be slow enough (1 mL per minute) to prevent too rapid expansion of plasma volume.

In the treatment of shock the amount of albumin and duration of therapy must be based on the responsiveness of the patient as indicated by blood pressure, degree of pulmonary congestion, and hematocrit. The initial dose may be followed by additional albumin within 15-30 minutes if the response is deemed inadequate. If there is continued loss of protein, it may be desirable to give packed red blood cells.

In the treatment of burns an optimal regimen involving use of albumin, crystalloids, electrolytes and water has not been established. Suggested therapy during the first 24 hours includes administration of large volumes of crystalloid solution to maintain an adequate plasma volume. Continuation of therapy beyond 24 hours usually requires more albumin and less crystalloid solution to prevent marked hemoconcentration and maintain electrolyte balance. Duration of treatment varies depending upon the extent of protein loss through renal excretion, denuded areas of skin and decreased albumin synthesis. Attempts to raise the albumin level above 4.0 g/100 mL may only result in an increased rate of catabolism.

In the treatment of hypoproteinemia, 200 to 300 mL of 25% albumin may be required to reduce edema and to bring serum protein values to normal. Since such patients usually have approximately normal blood volume, doses of more than 100 mL of 25% albumin should not be given faster than 100 mL in 30 to 45 minutes to avoid circulatory embarrassment. If slower administration is desired, 200 mL of 25% albumin may be mixed with 300 mL of 10% dextrose solution and administered by continuous drip at a rate of 100 mL of this dextrose solution an hour.

Other:
Indication Dose

Hypovolemia

Adults: 25 g
Children (less than 13 years): 2.5 to 1.25 g to children

Hypoalbuminemia

Adults: 50 to 75 g

Prevention of volume depletion after paracentesis

Adults: 8 g for every 1,000 mL of ascitic fluid removed

Ovarian hyperstimulation syndrome

Adults: 50 to 100 g over 4 hours and repeated at 4-12 hour intervals as necessary

Adult respiratory distress syndrome

Adults: 25 g over 30 minutes and repeated at 8 hours for 3 days, if necessary

Acute nephrosis

Adults: 25 g together with diuretic once a day for 7-10 days

Hemolytic Disease of the Newborn

1 g per kilogram body weight prior or during exchange transfusion



HOW SUPPLIED
Albuminar®-25 is supplied as a 25% solution. Each product presentation includes a package insert and the following component:
20 mL -One vial containing 5 grams of albumin
50 mL -One vial containing 12.5 grams of albumin
100 mL -One vial containing 25 grams of albumin


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Albumin (5%)
5
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CLINICAL PHARMACOLOGY
Albuminar®-5, being active osmotically, is useful in regulating the volume of circulating blood. It is a valuable therapeutic aid for the treatment of conditions that will be benefited by its marked osmotic effect. When the circulating blood volume has been depleted, the hemodilution following albumin administration persists for many hours. In individuals with normal blood volume, it usually lasts only a few hours.

Albumin (Human), unlike whole blood or plasma, is considered free of the danger of viral hepatitis because it is heated at 60ºC for 10 hours. It is convenient to use since no cross-matching is required and the absence of cellular elements removes the danger of sensitization with repeated infusions.
INDICATIONS AND USAGE
SHOCK
Albuminar®-5 is indicated in the emergency treatment of shock due to burns, trauma, operations and infections, in the treatment of severe injuries, and in other similar conditions where the restoration of blood volume is urgent. The primary function is maintenance of colloid osmotic pressure. If there has been considerable loss of red blood cells, transfusion with packed red blood cells is indicated.

BURNS
Albuminar®-5 is indicated in conjunction with adequate infusions of crystalloid to counteract hemoconcentration and the loss of protein, electrolytes and water that usually follow severe burns. Because of changes in permeability, little administered albumin is likely to be retained intravenously in the first 12 hours after a major burn. However, an optimum regimen for the use of colloid, electrolytes and water in the treatment of burns has not been established.

HYPOPROTEINEMIA
Albuminar®-5 may be used in acutely hypoproteinemic patients, provided sodium restriction is not a problem.

DOSAGE AND ADMINISTRATION
Albuminar®-5 may be given intravenously without further dilution. This concentration is approximately isotonic and iso-osmotic with citrated plasma. Albumin (Human) in this concentration provides additional fluid for plasma volume expansion. Therefore, when it is administered to patients with normal blood volume, the rate of infusion should be slow enough to prevent too rapid expansion of plasma volume.

In the treatment of shock in an adult patient an initial dose of 500 mL of the 5% albumin solution is given as rapidly as tolerated. If response within 30 minutes is inadequate, an additional 500 mL of 5% albumin solution may be given. The 50 mL dosage form would be appropriate for pediatric use, with a dose of 10-20 mL per kg of body weight infused intravenously at a rate up to 5-10 mL per minute. Therapy should be guided by the clinical response, blood pressure and an assessment of relative anemia. If more than 1000 mL are given, or if hemorrhage has occurred, the administration of packed red blood cells may be desirable.

In severe burns, immediate therapy should include large volumes of crystalloid with lesser amounts of 5% albumin solution to maintain an adequate plasma volume. After the first 24 hours, the ratio of albumin to crystalloid may be increased to establish and maintain a plasma albumin level of about 2.5 g/100 mL or a total serum protein level of about 5.2 g/100 mL. However, an optimal regimen for the use of colloids, electrolytes and water after severe burns has not been established.

The infusion of Albumin (Human) as a nutrient in the treatment of chronic hypoproteinemia is not recommended. In acute hypoproteinemia, 5% albumin may be used in replacing the protein lost in hypoproteinemic conditions. However, if edema is present or if large amounts of albumin are lost, Albumin (Human) 25% is preferred because of the greater amount of protein in the concentrated solution.

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.

HOW SUPPLIED
Albuminar®-5 is supplied as a 5% solution. Each product presentation includes a package insert and the following component:
50 mL - One vial containing 2.5 grams of albumin
250 mL - One bottle containing 12.5 grams of albumin
500 mL - One bottle containing 25 grams of albumin

Store between 20-25ºC (68-77ºF); excursions permitted to 15-30ºC (59-86ºF) [See USP Controlled Room Temperature].

References  top of page

[1]  Hillyer, CD. Blood Banking and Transfusion Medicine: Basic Principles & Practice. Churchill Livingstone/ Elsevier Health Sciences, 2007. pp 281, 282.
Infusion rates:  "Because high rates of albumin infusion can cause circulatory overload and pulmonary edema, 5% albumin solutions are commonly started at a rate of 1 to 2 mL/min and are not usually infused at a faster rate than 4 mL/min, and 25% albumin solutions are not infused at rates faster than 1 mL/min."

[2] Lexi-Comp, Inc. (Lexi-Drugs). Lexi-Comp, Inc.;   Accessed: February 17, 2014.

[3]  Package insert data: accessed Feb 17,2014.  Albumin (Human) 25 % - 12.5 g in 50 mL.  CSL Behring LLC.  Kankakee, IL 60901 USA.  US License No. 1767. Revised August, 2012. 

[4]  Package insert data: accessed Feb 17,2014.  Albumin (Human) 25 % - 12.5 g in 50 mL.  Octapharma USA Inc. 121 River Street, 12 th floor. Hoboken, NJ 07030. Revised: 8/2008.

[5]  Package insert data: accessed Feb 17,2014.  Albuminar®-5 - Albumin (Human) USP 5% 250 mL. CSL Behring LLC. Kankakee, IL 60901 USA.



Disclaimer  top of page

All calculations must be confirmed before use. The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgement. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.   Read the disclaimer
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