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Plasma Protein Solution — Colloid Pregnancy: Safe — used in hypoalbuminaemia of pregnancy; no teratogenic risk from pasteurised product

Human Albumin Solution (Surgical — Volume/Oncotic)

Brand names: Albuman, Alburex, Zenalb

Adult dose

Dose: 4–5% albumin: 250–500 mL IV for volume resuscitation; 20–25% albumin: 100 mL IV for oncotic support (e.g. post-paracentesis, HRS, hypoalbuminaemia <20 g/L preoperatively)
Route: IV infusion
Frequency: As clinically indicated
Max: No fixed maximum — guided by serum albumin, fluid balance, and clinical response
4–5% albumin is iso-oncotic — used for volume resuscitation in burns, post-paracentesis, HRS. 20% albumin is hyperoncotic — draws fluid from extravascular space. Pre-operative albumin optimisation: albumin <30 g/L is an independent predictor of postoperative complications (NICE perioperative guidance).

Paediatric dose

Dose: 5–10 mL/kg
Route: IV
Frequency: As needed
Max: Guided by response and fluid balance
Neonatal: 4.5% albumin for volume resuscitation — 10–20 mL/kg IV over 30 min. BNFc: not routinely used for routine volume replacement in children. (of 4–5% solution)

Dose adjustments

Renal

Use with caution in oliguric renal failure — volume overload risk.

Hepatic

Useful in hepatic failure — cirrhotic patients have low endogenous albumin production; 20% albumin used post-paracentesis to prevent PPCD (post-paracentesis circulatory dysfunction).

Paediatric weight-based calculator

Neonatal: 4.5% albumin for volume resuscitation — 10–20 mL/kg IV over 30 min. BNFc: not routinely used for routine volume replacement in children. (of 4–5% solution)

Clinical pearls

  • SAFE trial (NEJM 2004): 4% albumin vs 0.9% saline for ICU resuscitation — no overall mortality difference; subgroup: WORSE outcomes with albumin in TBI; BETTER outcomes in sepsis. Current practice: albumin for specific indications (burns, post-paracentesis, septic shock albumin replacement, HRS), NOT for routine surgical resuscitation
  • Pre-operative albumin optimisation: CPOC guidelines (2021) — albumin <25 g/L warrants pre-operative nutrition optimisation (oral supplements or NG feeding) before elective major surgery; albumin 25–35 g/L with adequate time before surgery: nutritional support. Emergency surgery — give albumin plus early enteral nutrition post-op
  • Burns resuscitation (Parkland modification): albumin 5% added after 8–24 hours to Parkland formula crystalloid in burns >40% TBSA — reduces fluid creep and oedema

Contraindications

  • Cardiac failure (high-volume 4–5% albumin — volume overload risk)
  • Severe anaemia
  • Hypervolaemia

Side effects

  • Fluid overload (high-volume use)
  • Anaphylactoid reactions (rare — 1:100,000)
  • Dilutional hyponatraemia
  • Transmission risk (theoretically eliminated — pasteurised and heat-treated)

Interactions

  • Binding of drugs to albumin altered — monitor free drug levels for highly protein-bound drugs (phenytoin, warfarin, valproate) in hypoalbuminaemia

Monitoring

  • Serum albumin (target >30 g/L pre-operatively for elective cases)
  • Fluid balance
  • BP and CVP/CO during infusion
  • Signs of fluid overload (JVP, pulmonary oedema)

Reference: BNFc; BNF 90; SAFE Trial (NEJM 2004); NICE CPOC Perioperative Guidelines 2021; EASL Post-Paracentesis Guidelines; MHRA Blood Components Safety Update. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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