Have you encountered the following misconceptions about albumin use? 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 a nutritional indicator. It is due to the systemic inflammatory response, increased vascular permeability, albumin migration, and the inhibition of hepatic albumin mRNA expression and increased albumin breakdown. 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 is not different from eating ordinary high-protein foods, and it 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, which may lead to adverse reactions such as increased blood sodium. The human 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 amino acids of the breakdown products of albumin are not comprehensive and lack amino acids for synthesizing other proteins such as tryptophan. 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 amounts of energy (fat emulsion with glucose) and nutritional substrates (balanced amino acid preparations). In fact, globulin, not albumin, is involved in the formation of the body’s immune system. In fact, globulin, not albumin, is involved in the formation of the body’s immune mechanism, and high-dose infusions of albumin not only do not 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 amounts of endotoxin, vasodilator, and trace amounts of α1-acid glycoprotein. These substances may have an “interference” effect on the immune function of the body. Myth 3: Albumin is the drug of choice for volume replacement The UHC Guidelines for the Use of Human Albumin, Nonprotein Colloids, and Crystalloids state that human albumin is not the drug of choice for volume replacement in patients with hypovolemia and is only a second-line alternative. Current evidence-based medical evidence suggests that in surgical patients, different types of colloid solutions do not show significant differences for outcome indicators of morbidity and mortality, 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 clinical use of human albumin state that human albumin is recommended for critically ill patients with very low albumin levels (<15 g/L), and if the albumin level is 15-20 g/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 denied. However, the human blood albumin currently used is inactivated by heating at 60 ℃ for 10 hours when stabilizers are available. Under these conditions, viruses such as HBV, HCV and HIV are no longer infectious and the albumin is non-antigenic and can be infused repeatedly. Therefore, albumin infusion is actually much safer than plasma or whole blood infusion. The correct use of albumin After reading so many misconceptions and contraindications, how should albumin be used in the end? Indications for albumin 1. 24 h after large burns; 2. Acute traumatic shock; 3. Adult acute respiratory distress syndrome; 4. Adjunctive treatment of hemodialysis; 5. Prevention and treatment of hypoproteinemia; 6. Oedema or ascites caused by cirrhosis and nephropathy; 7. Acute hepatic failure with hepatic coma; 8. Cranial pressure elevation caused by cerebral edema and injury; 9. Patients with plasma albumin <25 g/L are also considered as indications for which albumin preparations can be used. 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 some cases of acute massive blood loss (>40% blood volume), albumin preparations may be considered because the liver is unable to synthesize sufficient albumin in time. Dosage and Administration Use: I.V. (preferably with a blood transfusion device equipped with a strainer) or push. Drip rate: Slowly for the first 15 min, gradually accelerate to 2 ml/min, but do not exceed this rate. Dosage: The dosage should be considered according to the patient’s clinical symptoms. Generally, for severe burns or shock due to blood loss, 5-10 g of this product can be injected directly, and the injection should be repeated every 4-6 hours. In the treatment of albumin deficiency caused by chronic diseases such as kidney disease and liver cirrhosis, 5-10 g of this product can be injected daily until the edema disappears. Albumin dose formula Required dose (g) = (desired albumin level – current level) (g/L) x 2 x plasma volume (L) where multiplication by 2 is due to the fact that the tissue interstitial space will absorb half of the infused dose, taking into account the usual deficiency of albumin in the tissue interstitial space. The actual dose should also be determined by the patient’s specific test results, and the purpose of albumin supplementation is to achieve a critical mass. Tips: 1. Albumin should not be mixed with vasoconstrictors, protein hydrolases or alcohol-containing injections. 2.After opening, the infusion should be completed in one dose and not divided into different doses. 3.If patients are found to have uncomfortable reactions during the infusion process, the infusion should be stopped immediately; those who are obviously dehydrated should be rehydrated at the same time. 4. Freezing is strictly prohibited during transportation and storage.