Buminate


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albumin (human)

(al-byoo-min) ,

Albuminar

(trade name),

Albutein

(trade name),

Buminate

(trade name),

normal human serum albumin

(trade name),

Plasbumin

(trade name)

Classification

Therapeutic: volume expanders
Pharmacologic: blood products
Pregnancy Category: C

Indications

Expansion of plasma volume and maintenance of cardiac output in situations associated with fluid volume deficit, including shock, hemorrhage, and burns.Temporary replacement of albumin in diseases associated with low levels of plasma proteins, such as nephrotic syndrome or end-stage liver disease, resulting in relief or reduction of associated edema.

Action

Provides colloidal oncotic pressure, which serves to mobilize fluid from extravascular tissues back into the intravascular space.
Requires concurrent administration of appropriate crystalloid.

Therapeutic effects

Increase in intravascular fluid volume.

Pharmacokinetics

Absorption: Following IV administration, absorption is essentially complete.
Distribution: Confined to the intravascular space, unless capillary permeability is increased.
Metabolism and Excretion: Probably degraded by the liver.
Half-life: 2–3 wk.

Time/action profile (oncotic effect)

ROUTEONSETPEAKDURATION
IV15–30 minunknown24 hr

Contraindications/Precautions

Contraindicated in: Allergic reactions to albumin;Severe anemia;HF;Normal or increased intravascular volume.
Use Cautiously in: Severe hepatic or renal disease;Dehydration (additional fluids may be required);Patients requiring sodium restriction;Preterm neonates (infuse slowly due to increased risk of intravascular hemorrhage).

Adverse Reactions/Side Effects

Central nervous system

  • headache

Cardiovascular

  • pulmonary edema (life-threatening)
  • fluid overload
  • hypertension
  • hypotension
  • tachycardia

Gastrointestinal

  • increased salivation
  • nausea
  • vomiting

Dermatologic

  • rash
  • urticaria

Musculoskeletal

  • back pain

Miscellaneous

  • chills
  • fever
  • flushing

Interactions

Drug-Drug interaction

None significant.

Route/Dosage

Dose is highly individualized and depends on condition being treatedHypovolemic shock—5% Albumin
Intravenous (Adults) 25 g (500 mL), may be repeated within 30 min.
Intravenous (Children) 0.5–1 g/kg/dose (10–20 mL/kg/dose) may repeat as needed (maximum 6 g/kg/day).
Intravenous (Infants and Neonates) 0.25–0.5 g/kg/dose (5–10 mL/kg/dose).
Hypoproteinemia—25% Albumin
Intravenous (Adults) 50–75 g.
Intravenous (Children, Infants, and Neonates) 0.5–1 g/kg/dose, may repeat every 1–2 days; doses up to 1.5 g/kg/day have been added to hyperalimentation solutions and given over 24 hr.
Nephrotic Syndrome—25% Albumin
Intravenous (Adults) 12.5–50 g/day in 3–4 divided doses.
Intravenous (Children and Infants) 0.25–1 g/kg/dose.

Availability

Injection: 5% (50 mg/mL), 25% (250 mg/mL)

Nursing implications

Nursing assessment

  • Monitor vital signs, CVP, and intake and output before and frequently throughout therapy. If fever, tachycardia, or hypotension occurs, stop infusion and notify physician immediately. Antihistamines may be required to suppress this hypersensitivity response. Hypotension may also result from infusing too rapidly. May be given without regard to patient's blood group.
    • Assess for signs of vascular overload (elevated CVP, rales/crackles, dyspnea, hypertension, jugular venous distention) during and after administration.
  • Surgical Patients: Assess for increased bleeding after administration caused by increased BP and circulating blood volume. Albumin does not contain clotting factors.
  • Lab Test Considerations: Serum albumin levels should increase with albumin therapy.
    • Monitor serum sodium levels; may cause ↑ concentrations.
    • Infusions of normal serum albumin may cause false ↑ of alkaline phosphatase levels.
    • Hemorrhage: Monitor hemoglobin and hematocrit levels. These values may ↓ because of hemodilution.

Potential Nursing Diagnoses

Decreased cardiac output (Indications)
Deficient fluid volume (Indications)
Excess fluid volume (Side Effects)

Implementation

  • Follow manufacturer’s recommendations for administration. Administer through a large-gauge (at least 20-gauge) needle or catheter. Record lot number in patient record.
    • Solution should be clear amber; 25% albumin solution is equal to 5 times the osmotic value of plasma. Do not administer solutions that are discolored or contain particulate matter. Each L of both 5% and 25% albumin contains 130–160 mEq of sodium and is thus no longer labeled "salt-poor’’ albumin.
    • Administration of large quantities of normal serum albumin may need to be supplemented with whole blood to prevent anemia. If more than 1000 mL of 5% normal serum albumin is given or if hemorrhage has occurred, the administration of whole blood or packed RBCs may be needed. Hydration status should be monitored and maintained with additional fluids.
  • Intravenous Administration
  • pH: 6.4–7.4.
  • Intermittent Infusion: Diluent: Administer 5% normal serum albumin undiluted. Normal serum albumin 25% may be administered undiluted or diluted in 0.9% NaCl, D5W, or sodium lactate injection; do not dilute in sterile water (may result in hypotonic-associated hemolysis which may be fatal). Infusion must be completed within 4 hr.Concentration: 5%: 50 mg/mL undiluted. 25%: 250 mg/mL undiluted.
  • Rate: Rate of administration is determined by concentration of solution, blood volume, indication, and patient response (usual rate over 30–60 min). In patients with normal blood volume, rate of 5% and 25% solutions should not exceed 2–4 mL/min and 1 mL/min, respectively, for both adults and children.
    • Hypovolemia: 5% or 25% normal serum albumin may be administered as rapidly as tolerated and repeated in 15–30 min if necessary.
    • Burns: Rate after the first 24 hr should be set to maintain a plasma albumin level of 2.5 g/100 mL or a total serum protein level of 5.2 g/100 mL.
    • Hypoproteinemia: Normal serum albumin 25% is the preferred solution because of the increased concentration of protein. The rate should not exceed 2–3 mL/min of 25% or 5–10 mL/min of 5% solution to prevent circulatory overload and pulmonary edema. This treatment provides a temporary rise in plasma protein until the hypoproteinemia is corrected.
  • Y-Site Compatibility: diltiazem, lorazepam
  • Y-Site Incompatibility: fat emulsion, midazolam, vancomycin, verapamil
  • Solution Compatibility: 0.9% NaCl, D5W, D5/0.9% NaCl, D5/0.45% NaCl, sodium lactate 1/6M, D5/LR, and LR.

Patient/Family Teaching

  • Explain the purpose of this solution to the patient.
  • Instruct patient to report signs and symptoms of hypersensitivity reaction.

Evaluation/Desired Outcomes

  • Increase in BP and blood volume when used to treat shock and burns.
  • Increased urinary output reflects the mobilization of fluid from extravascular tissues.
  • Elevated serum plasma protein in patients with hypoproteinemia.

Buminate

a trademark for a blood volume expander (human albumin).