NORMAL SERUM ALBUMIN, HUMAN

(al-byoo'min)

Albuminar, Albutein, Buminate, Plasbumin
Classifications: plasma derivative; plasma volume expander;
Therapeutic: plasma volume expander
Pregnancy Category: C

Availability

5%, 20%, 25% injection

Action

Obtained by fractionating pooled venous and placental human plasma, which is then sterilized by filtration and heat to minimize possibility of transmitting hepatitis B virus or HIV. Risk of sensitization is reduced because it lacks cellular elements and contains no coagulation factors, Rh factor, or blood group antibodies. Plasma volume expander that increases the osmotic pressure of plasma.

Therapeutic Effect

Expands volume of circulating blood by osmotically shifting tissue fluid into general circulation.

Uses

To restore plasma volume and maintain cardiac output in hypovolemic shock; for prevention and treatment of cerebral edema; as adjunct in exchange transfusion for hyperbilirubinemia and erythroblastosis fetalis; to increase plasma protein level in treatment of hypoproteinemia; and to promote diuresis in refractory edema. Also used for blood dilution prior to or during cardiopulmonary bypass procedures. Has been used as adjunct in treatment of adult respiratory distress syndrome (ARDS).

Contraindications

Hypersensitivity to albumin; severe anemia; cardiac failure; within 24 h of severe burns; heart failure; patients with normal or increased intravascular volume; pregnancy (category C).

Cautious Use

Low cardiac reserve, pulmonary disease, absence of albumin deficiency; liver or kidney failure, dehydration, hypertension, hypernatremia; restricted sodium intake.

Route & Dosage

Emergency Volume Replacement
Adult: IV 25 g, may repeat in 15–30 min if necessary (max: 250 g)

Colloidal Volume Replacement (Nonemergency)
Child: IV 12.5 g, may repeat in 15–30 min if necessary

Hypoproteinemia
Adult: IV 50–75 g (max: 2 mL/min)
Child: IV 25 g (max: 2 mL/min)

Administration

Intravenous

Note: 5% solution = 5 g/100 mL; 25% solution = 25 g/mL.

PREPARE: IV Infusion: Normal serum albumin, 5%, is infused without further dilution. Normal serum albumin, 25%, may be infused undiluted or diluted in NS or D5W (with sodium restriction).

ADMINISTER: IV Infusion for Hypovolemic Shock: Give initially as rapidly as necessary to restore blood volume. As blood volume approaches normal, rate should be reduced to avoid circulatory overload and pulmonary edema. Give 5% albumin at rate not exceeding 2–4 mL/min. Give 25% albumin at a rate not to exceed 1 mL/min. IV Infusion with Normal Blood Volume: Give 5% albumin human at a rate not to exceed 5–10 mL/min; give 25% albumin at a rate not to exceed 2 or 3 mL/min. IV Infusion for Children: Usual rate is 1/4–? the adult rate.

INCOMPATIBILITIES Solution/additive: Amino acids, verapamil. Y-site: Fat emulsion, midazolam, vancomycin, verapamil.

Store at temperature not to exceed 37° C (98.6° F).
Use solution within 4 h, once container is opened, because it contains no preservatives or antimicrobials. Discard unused portion.

Adverse Effects (≥1%)

Body as a Whole: Fever, chills, flushing, increased salivation, headache, back pain. Skin: Urticaria, rash. CV: Circulatory overload, pulmonary edema (with rapid infusion); hypotension, hypertension, dyspnea, tachycardia. GI: Nausea, vomiting.

Diagnostic Test Interference

False rise in alkaline phosphatase when albumin is obtained partially from pooled placental plasma (levels reportedly decline over period of weeks).

Nursing Implications

Assessment & Drug Effects

Monitor BP, pulse and respiration, and IV albumin flow rate. Adjust flow rate as needed to avoid too rapid a rise in BP.
Lab tests: Monitor dosage of albumin using plasma albumin (normal): 3.5–5 g/dL; total serum protein (normal): 6–8.4 g/dL; Hgb; Hct; and serum electrolytes.
Observe closely for S&S of circulatory overload and pulmonary edema (see Appendix F). If S&S appear, slow infusion rate just sufficiently to keep vein open, and report immediately to physician.
Monitor I&O ratio and pattern. Report changes in urinary output. Increase in colloidal osmotic pressure usually causes diuresis, which may persist 3–20 h.
Withhold fluids completely during succeeding 8 h, when albumin is given to patients with cerebral edema.

Patient & Family Education

Report chills, nausea, headache, or back pain to physician immediately.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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