It is common to hear doctors ask pharmacies about the availability of albumin, but behind this oversupply of albumin there are many cases of irrational use. Have you encountered the following misconceptions about the use of albumin? Myth 1: Albumin has high nutritional value and can strengthen the body Hypoalbuminemia can only be used as an indicator of the degree of inflammation in the body, but not as a nutritional indicator. It is due to the systemic inflammatory response state, enhanced vascular permeability, outward migration of albumin, as well as the inhibition of hepatic albumin mRNA expression and increased albumin catabolism. Timing of dosing The physiological nutritional effect of albumin is only as a source of nitrogen in the body when nitrogen metabolism is impaired. The application of albumin in people with normal nitrogen metabolism does not differ from eating ordinary high-protein foods and does more harm than good. The infusion of exogenous albumin to patients with normal albumin content will, on the contrary, inhibit the synthesis of the body’s own albumin and accelerate the breakdown of albumin. It also increases the circulatory load and may lead to adverse effects such as increased blood sodium. Low utilization rate The body can only use the amino acids generated by the degradation of albumin, and the half-life of albumin is about 21d, so the albumin input on the same day can not play a nutritional role. Moreover, the breakdown products of albumin do not have a full range of amino acids, and lack amino acids such as tryptophan, which are used to synthesize other proteins. So it seems that the nutritional value of albumin may not be as high as many people think. In conclusion, the root cause of malnutrition is insufficient intake or impaired utilization of nitrogen and calories by the body. Therefore, patients with malnutrition should be provided with adequate and reasonably well-matched energy (fat emulsions with glucose) and nutritional substrates (balanced amino acid preparations). Myth 2: Albumin can improve the immunity of the body In fact, it is globulin, not albumin, that is involved in the formation of the body’s immune mechanism. In fact, globulin, not albumin, is involved in the formation of the body’s immune mechanism, and high-dose infusion of albumin not only cannot improve immunity, but may cause a decline in the body’s immune function. This is because albumin preparations contain certain biologically active substances, such as trace endotoxin, vasodilator, trace α1-acidic glycoprotein, etc.. These substances may have an “interference” effect on the immune function of the body. Myth 3: Albumin is the drug of choice for blood volume supplementation In patients with hypovolemia, human albumin is not the drug of choice for blood volume supplementation and is only a second-line alternative. Current evidence-based medical evidence suggests that in surgical patients, different types of colloid fluids do not show significant differences in outcome indicators of morbidity and mortality and complication rates, and that albumin infusion in burn patients may also increase morbidity and mortality. Myth 4: Albumin should be widely used for the treatment of critically ill patients Currently, there is no evidence that the use of albumin has a significant role in the treatment of critically ill patients and in improving the prognosis of the disease. The UHC guidelines for the clinical use of human albumin state that human albumin is recommended for critically ill patients with very low albumin levels (<15g/L), and if the albumin level is 15-20g/L, it should be used depending on the patient's condition. And patients with acute pancreatitis and other conditions are not suitable for albumin. Our instructions also state that hypertension, acute heart disease, normovolemic and hypervolemic heart failure, severe anemia and renal insufficiency are contraindications to albumin. In addition, the input of albumin for patients with advanced malignant tumor may also accelerate the growth of tumor. It not only does not promote the recovery of patients' body, but also increases the burden of liver and kidney and worsens the condition. Therefore, although albumin is good, it should not be abused! Myth 5: Albumin may spread infectious diseases such as hepatitis B. Although theoretically, this possibility cannot be completely denied. However, the human blood albumin currently used is inactivated by heating at 60°C for 10 hours when a stabilizer is available. Under such conditions, viruses such as HBV, HCV and HIV have lost their infectivity and the albumin is non-antigenic and can be infused repeatedly. Therefore, the infusion of albumin is actually much safer than the infusion of plasma or whole blood. The correct use of albumin Indications for albumin 1. 24h after large burns; 2. acute traumatic shock; 3. acute respiratory distress syndrome in adults; 4. adjuvant treatment of hemodialysis; 5. prevention and treatment of hypoproteinemia; 6. edema or ascites caused by cirrhosis and nephropathy; 7. acute liver failure with hepatic coma; 8. cerebral edema and elevated cranial pressure caused by injury; 9. neonatal hyperbilirubinemia bilirubinemia, etc.; and for patients with plasma albumin <25g/L, it is also considered as an indication for the use of albumin preparations. Since albumin in such patients, unable to complete normal intra- and extravascular fluid exchange, cannot effectively assume the role of drug carrier. In addition, in certain cases of acute massive blood loss (>40% blood volume), the application of albumin preparations may also be considered because the liver is unable to synthesize sufficient albumin in time. Dosage Dosage: IV (preferably with a blood transfusion device equipped with a strainer) or IV push, with appropriate dilution in 5% glucose or sodium chloride solution. Drip rate: slow for the first 15 min, gradually accelerate to 2 ml/min, but do not exceed this rate. Dosage: should be considered according to the patient’s clinical symptoms as appropriate: in general, for shock due to severe burns or blood loss, 5-10g of this product can be injected directly, and then repeated at 4-6h intervals. In the treatment of albumin deficiency caused by chronic diseases such as kidney disease and liver cirrhosis, 5-10g of this product can be injected daily until the edema disappears. Albumin dose formula Required dose (g) = (desired attained albumin level – existing level) (g/L) × 2 × plasma volume where multiplication by 2 is due to the fact that half of the infused dose will be absorbed by the tissue interstitium, considering the deficiency state of albumin that usually exists in the tissue interstitium. The actual dose should also be determined by the patient’s specific test results, and the purpose of albumin supplementation is to reach a critical threshold. Tips 1. Albumin should not be mixed with vasoconstrictors, protein hydrolases or alcohol-containing injections. 2.After opening, it should be infused at once and should not be used in separate doses. 3.If patients have any uncomfortable reaction during the infusion, the infusion should be stopped immediately; those who have obvious dehydration should be rehydrated at the same time. 4. Freezing is strictly prohibited during transportation and storage.