Albumin can be valuable when used appropriately. Inappropriate use is expensive and does not benefit the patient.


Indications associated with hypotension:

(1) hemorrhagic shock with hypotensive criteria

(2) nonhemorrhagic shock with hypotensive criteria

(3) hemodialysis-associated hypotension with hypotensive criteria


Hypotensive criteria - both of the following:

(1) systolic blood pressure < 80 mm Hg

(2) central venous pressure < 6 mm Hg or pulmonary capillary wedge pressure < 10 mm Hg


Indications for acute protein loss:

(1) following paracentesis for ascites, with removal of > 1,500 mL (Stump et al > 3,000 mL) of fluid and no peripheral edema

(2) acute nephrotic syndrome with > 3 grams of protein per 24 hours and peripheral edema

(3) burn injury (see criteria)


Burns - one or more of the following

(1) second and third degree burns involving > 40% of body surface area

(2) third degree burns involving > 20% of body surface area


Neurosurgical indications:

(1) maintenance of cerebral perfusion pressure when cerebral edema present


Possible indications:

(1) open-heart surgery, to prime pump

(2) major retroperitoneal surgery

(3) following liver transplantation

(4) peritonitis with hypoalbuminemia

(5) acute respiratory distress syndrome on mechanical ventilation

(6) vasospasm after subarachnoid hemorrhage



(1) malnutrition

(2) chronic cirrhosis

(3) chronic nephrotic syndrome



(1) patient unable to handle the oncotic load despite diuresis (severe heart failure, hyperviscosity syndrome, etc.)


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