Albumin Replacement Therapy to Treat Protein Losing Enteropathy (PLE)

What is Albumin?

Albumin: The main protein in human blood and the key to the regulation of the osmotic pressure of blood. Chemically, albumin is soluble in water, precipitated by acid, and coagulated by heat.

(Note: albumin is spelled with an "i" while "albumen" with an "e" is the white of an egg, the part of the egg from which meringues are made. "Albus" in Latin is white.)

**MY EXPERIENCE***

The spilling (Loss) of albumin that I experience is severe. In fact, it was suggested by my doctor that infusing albumin in me would be a waste of time.

My serum albumin measured <1 while my total serum protein was 1.9. Over a period of 7 years, I’ve been given albumin at differing doses, intervals and speeds.

Most recently, I was given 50mg albumin infused over 1 hour. Then 30 minutes later I was given 60ml lasix IV (push). This was repeated every 8 hrs for 5 days.

The net effect of this was a decrease in edema. My weight dropped from 165 to 133 lbs.in that same time interval.

Side effects of albumin that I noticed was a dull, uncomfortable headache.

Albumin (Human) 25% USP

Indications:

Emergency treatment of hypovolemic shock, burn therapy, cardiopulmonary bypass

Hypoproteinemia with or without edema, adult respiratory distress syndrome (ARDS)

Acute liver failure, neonatal hemolytic disease

Erythrocyte resuspension, sequestration of protein rich foods

Acute neophrosis

Contraindications:

Chronic nephrosis

History of CHF, renal insufficiency, or stabilized chronic anemia

Precautions:

Pregnancy category C

Monitor against signs of circulatory overload. Albumin 25% is hyperoncotic, therefore, in the presence of dehydration, albumin must be followed by addition of fluids.

In presence of hemorrhage, albumin should be supplemented by the transfusion of whole blood to treat the relative anemia associated with hemodilution. When circulating blood volume has been reduced, hemodilution following the administration of albumin persists for many hours. In patients with normal blood volume, hemodilution lasts for a much shorter time.

The rapid rise in blood pressure may follow the administration of a colloid with positive oncotic activity necessitates careful observation to detect and treat severed blood vessels which may not have bled at the lower blood pressure.

Adverse Reactions (Side Effects):

Rare: Such reactions may be allergic in nature or due to high plasma protein levels from excessive albumin administration. Allergic manifestations include urticaria, chills, fever, and changes in pulse, respiration and blood pressure.

Dosage:

Always administered by intravenous infusion; albumin 25% may be administered undiluted or diluted in 0.9% Sodium Chloride or 5% Dextrose in Water.

Hypovolemic shock:
The volume administered and the speed of infusion should be adapted to the response of the patient

Burns:
After a burn injury (usually 24 hours) there is a close correlation between the amount of albumin infused and the resultant increase in plasma colloid osmotic pressure. The aim should be to maintain the plasma albumin concentration in the region of 2.5 , plus or minus 0.5g, per 100ml with a plasma oncotic pressure of 22 mm Hg. This is best achieved by IV administration of albumin 25%. The duration of therapy is decided by the loss of protein from the burned areas and in the urine, In addition, oral or parenteral feeding with amino acids should be initiated, as the long-term administration of albumin should not be considered as a source of nutrition.

Hypoproteinemia with or without edema:
Unless the underlying pathology for hypoproteinemia can be corrected, the IV administration of albumin 25% must be considered purely symptomatic or supportive. The usual daily dose of albumin for adults is 50 to 75g and for children 25g. Patients with severe hypoproteinemia who continue to lose albumin may require larger quantities. Since hypoproteinemic patients usually have normal blood volumes, the rate of administration should not exceed 2 ml/min as more rapid injection may precipitate circulatory embarrassment and pulmonary edema.

Store at room temperature not exceeding 30 degrees C (86 degrees F).