In clinical practice, we often hear physicians asking pharmacies if albumin is available, 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 increased vascular permeability and migration of albumin in response to systemic inflammation, 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 use of albumin in people with normal nitrogen metabolism does not differ from eating ordinary high-protein foods and can cause 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 produced 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. The amino acids in the breakdown products of albumin are not comprehensive and lack amino acids such as tryptophan for the synthesis of 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, 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 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 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 blood volume replacement
The American Hospital Association Guidelines for the Use of Human Albumin, Nonprotein Colloids and Crystalloids (UHC) state that human albumin is not the drug of choice for volume replacement in patients with hypovolemia, but is 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 effect on the treatment of critically ill patients and on 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 such as acute pancreatitis 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 hepatitis B and other infectious diseases
Although theoretically this possibility cannot be denied completely. However, the human blood albumin currently used is inactivated by heating at 60 ℃ for 10 hours when stabilizer is 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 way to use albumin
After reading so many misconceptions and contraindications, how should albumin be used?
Indications for albumin
1. After 24 h of massive burns;
2. Acute traumatic shock;
3. Acute respiratory distress syndrome in adults;
4. Adjunctive therapy to hemodialysis. 5;
5. Prevention and treatment of hypoproteinemia;
6. edema or ascites due to liver cirrhosis and renal disease;
7. acute liver failure with hepatic coma;
8. cerebral edema and injury-induced elevated cranial pressure;
9. neonatal hyperbilirubinemia, etc;
Patients with plasma albumin <25 g/L are also considered as indications 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 some cases of acute massive blood loss (>40% blood volume), 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 filter) or IV push, with appropriate dilution in 5% glucose or sodium chloride.
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 due to 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 level of albumin – current level) (g/L) × 2 × plasma volume (L)
The multiplication by 2 is due to the fact that the tissue interstitium will absorb half of the infused dose, taking into account the usual deficiency of albumin in the tissue interstitium.
The actual dose should be determined by the patient’s specific test results, and albumin supplementation should be aimed at reaching a critical level.
Tips
1. Albumin should not be mixed with vasoconstrictors, proteolytic enzymes or alcohol-containing injections.
2. After opening, the infusion should be completed in a single dose and should not be divided into different doses.
3. Stop the infusion immediately if the patient has an uncomfortable reaction during the infusion; rehydrate the patient if there is obvious dehydration.
4. Freezing is strictly prohibited during transportation and storage.