Albumin (Human) is an intravenous (IV) colloid solution containing purified human serum albumin, which is the most abundant plasma protein. It is used to restore circulating blood volume in conditions such as hypovolaemia (low blood volume), hypoalbuminaemia (low albumin levels in blood), large-volume paracentesis (removal of fluid from the abdominal cavity) in people with cirrhotic ascites (swelling in the abdomen due to liver disease), spontaneous bacterial peritonitis (inflammation of tissue lining the abdomen), hepatorenal syndrome (severe kidney dysfunction), and burns. Albumin pulls fluid from the tissues back into the blood vessels, improving plasma volume and tissue perfusion.

Human albumin is a sterile, heat-treated protein solution prepared from pooled human plasma. It is supplied in 5%, 20%, and 25% strengths. The higher concentrations of albumin are hyperoncotic, which means they draw fluid into the vascular space, while 5% is iso-oncotic with normal plasma, so it expands blood volume roughly equal to the amount infused. Albumin makes up about half of total plasma protein and accounts for roughly 70 to 80% of plasma colloid osmotic pressure. It also transports bilirubin, fatty acids, hormones, calcium, and many drugs.

Clinically, albumin is used in the emergency treatment of hypovolaemia with or without shock, in the prevention of post-paracentesis circulatory dysfunction in cirrhosis, in spontaneous bacterial peritonitis, in hepatorenal syndrome, and as adjunctive therapy in severe hypoalbuminaemia, ovarian hyperstimulation syndrome (OHSS, complication of fertility treatments), and adult respiratory distress syndrome (ARDS), which causes fluid buildup in lungs and low blood oxygen levels. It is most effective in well-hydrated patients, since its volume-expanding effect depends on having interstitial fluid available to draw into circulation. Albumin is administered only by qualified clinicians, with dose, rate, and concentration tailored to the indication and the patient's haemodynamic status.

Hypovolaemia and shock

Restoration of blood volume, especially when crystalloids alone are insufficient to provide the required results.

Severe hypoalbuminaemia

To temporarily correct very low serum albumin in critically ill patients.

Cirrhotic ascites with large-volume paracentesis

To prevent the drop in blood pressure and circulatory problems that may occur after draining the abdominal fluid of patients with cirrhosis.

Spontaneous bacterial peritonitis (SBP)

As adjunctive therapy with antibiotics to lower renal failure risk and improve survival.

Hepatorenal syndrome (HRS)

With vasoconstrictors (agents that narrow blood vessels), to expand plasma volume and support renal perfusion.

Burns and selected cases of OHSS or ARDS

As supportive therapy after initial resuscitation.

• Rapidly increases plasma volume in the body and improves tissue perfusion in the case of hypovolaemia.

• Reduces post-paracentesis circulatory dysfunction in cirrhotic ascites.

• Improves survival in spontaneous bacterial peritonitis with antibiotics.

• Helps preserve renal function in hepatorenal syndrome (kidney failure in people with severe liver disease) alongside vasoconstrictor therapy.

• Free of red cell antigens, so no blood-group cross-matching is needed.

Common:

• Mild flushing, urticaria (hives), or rash
• Low-grade fever or chills
• Nausea, transient hypotension (low blood pressure) or tachycardia (rapid heart rate) during infusion

Uncommon:

• Headache, vomiting
• Hypertension (high blood pressure) after rapid infusion of hyperoncotic solutions

Serious side effects requiring immediate attention:

• Anaphylactic reactions, including bronchospasm (narrowing of airways) and severe hypotension
• Pulmonary oedema (fluid buildup in your lungs) and circulatory overload, especially in cardiac or renal compromise
• Electrolyte disturbances such as hypocalcaemia (low blood calcium levels) and dilutional hyponatraemia (low sodium levels)

Albumin is given through the veins (intravenously) by a healthcare professional in a clinical setting. Therefore, the concentration, dose, and rate of the medication depend on the indication, body weight, and serum albumin level of the patient. However, the daily dose should generally not exceed 2 g per kg body weight. Hyperoncotic solutions must not be diluted with sterile water for injection, as this causes haemolysis. Patients are monitored for fluid overload, hypersensitivity, and electrolyte imbalance during and after infusion.

Albumin is a 66.5 kDa (kilodalton) plasma protein that does not normally cross the healthy capillary wall. Because albumin remains within the blood vessels, it creates a pulling force (colloid osmotic pressure) that counteracts the pressure pushing fluid out of the capillaries. This pulling force draws fluid from the surrounding tissues back into the bloodstream, increasing blood volume, improving blood return to the heart, boosting the heart's output, and enhancing blood flow to the tissues.

In patients with cirrhotic ascites (fluid buildup in the peritoneal cavity, resulting in a swollen belly) and large-volume paracentesis, albumin acts against the rapid drop in circulating volume that follows fluid removal. This act prevents activation of the renin–angiotensin–aldosterone system (RAAS) and renal hypoperfusion (reduced blood flow to the kidneys). If RAAS gets activated, it can set off a chain leading to acute kidney injury, HRS, hyponatremia, recurrent ascites, and increased mortality

In sepsis and inflammation, the capillaries become leakier, so some albumin escapes from the bloodstream. This means its volume-boosting effect doesn't last as long as it would in non-inflammatory causes of hypovolaemia. Albumin also acts as a carrier for drugs and natural body substances, and helps protect against oxidative damage in the blood.

• No clinically significant food interactions, as albumin is given intravenously.

• Alcohol (CAUTION): Not a direct drug interaction, but alcohol may worsen the underlying conditions (cirrhosis, hepatorenal syndrome) for which albumin is prescribed.

• ACE inhibitors (CAUTION): Simultaneous administration has been linked to atypical reactions, including flushing and hypotension.

• Sterile water for injection (UNSAFE): Do not dilute hyperoncotic albumin with sterile water as this causes haemolysis (destruction of red blood cells) and acute kidney injury.

• Highly protein-bound drugs (CAUTION): Albumin can temporarily change the free fraction of drugs (not bound to plasma proteins) such as warfarin and phenytoin. However, the clinical impact is usually limited.

• Loop diuretics (BENEFICIAL): In hypoalbuminaemia and acute nephrosis, combined use can enhance diuresis.

• Severe anaemia or cardiac failure with normal/increased intravascular volume (Contraindicated): Risk of pulmonary oedema

• Pulmonary oedema or fluid overload (Caution): May worsen interstitial lung fluid.

• Severe renal impairment with oliguria (Caution): Risk of volume overload, hence close monitoring is required.

• Traumatic brain injury (Caution): Some evidence of increased mortality with albumin compared to saline, hence, it is generally avoided as a resuscitation fluid.

Excessive infusion can cause circulatory overload, resulting in hypertension, tachycardia, raised central venous pressure, pulmonary congestion and frank pulmonary oedema (severe stage) along with dilutional electrolyte disturbances. Management includes stopping the infusion immediately, positioning the patient upright, giving oxygen, and using diuretics or other haemodynamic measures under specialist care.

Albumin is not self-administered and is given only as part of an inpatient or supervised infusion protocol. Doses are scheduled and managed by your treating team, who will adjust timing if an infusion is delayed. Patients and caregivers should not attempt to manage albumin dosing independently.