Albumin for Hypoalbuminemia in the Elderly
Albumin for Hypoalbuminemia in the Elderly
Is it justifiable to administer 100 mL of 25% human albumin over 8-10 hours to a 70-year-old patient with hypoalbuminemia (< 2.5 g/dL) and compromised heart if we have to consider other factors, such as ambient/room temperature (around 32°C to 35°C), financial burden for the patient, and the stability of albumin after 4 hours? The setting is in a developing country (Indonesia).
Gunawan Kosasih, MD
Hypoalbuminemia occurs frequently among elderly people. Its prevalence ranges from 4% to 50% depending on whether patients live at home or in hospice and whether they are bedridden or not. In normal circumstances, albumin has a double function: to maintain oncotic pressure and to transport endogenous or exogenous substances. A low-serum albumin may in fact precipitate heart failure in patients with diastolic function. Albumin preparations obtained by separation of human plasma have been used clinically for more than 50 years to reverse hypoalbuminemia and to allow for reversal of abnormalities in substance transport. Controversy surrounds the administration of albumin, although a recent meta-analysis suggests a benefit of such therapy in a variety of clinical settings. Treatment of the underlying condition is paramount to an adequate response to albumin, although considering the cost and the possible complication of osmotic overload, I would suggest caution when using albumin in the setting detailed above.
Is it justifiable to administer 100 mL of 25% human albumin over 8-10 hours to a 70-year-old patient with hypoalbuminemia (< 2.5 g/dL) and compromised heart if we have to consider other factors, such as ambient/room temperature (around 32°C to 35°C), financial burden for the patient, and the stability of albumin after 4 hours? The setting is in a developing country (Indonesia).
Gunawan Kosasih, MD
Hypoalbuminemia occurs frequently among elderly people. Its prevalence ranges from 4% to 50% depending on whether patients live at home or in hospice and whether they are bedridden or not. In normal circumstances, albumin has a double function: to maintain oncotic pressure and to transport endogenous or exogenous substances. A low-serum albumin may in fact precipitate heart failure in patients with diastolic function. Albumin preparations obtained by separation of human plasma have been used clinically for more than 50 years to reverse hypoalbuminemia and to allow for reversal of abnormalities in substance transport. Controversy surrounds the administration of albumin, although a recent meta-analysis suggests a benefit of such therapy in a variety of clinical settings. Treatment of the underlying condition is paramount to an adequate response to albumin, although considering the cost and the possible complication of osmotic overload, I would suggest caution when using albumin in the setting detailed above.
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