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Albumin is the most
abundant extracellular protein, it’s distribution is primarily
intravascular.
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Albumin has a role in
maintaining COP, binding and transport, free radical scavenging, acid base
balance, coagulation and vascular permeability.
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Albumin is measured using
BCG or BCP. This overestimates a low serum albumin.
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Serum albumin
concentration falls due to decreased synthesis, increased catabolism,
increased loss and redistribution.
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The serum albumin falls
when patients become sick, and comes back up when patients get better. The
liver stops producing albumin in critical illness: low albumin is a non
specific marker of disease.
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Edema formation is
determined by the rate of fluid flux: COP is determined by total protein
concentration, and the state of the lymphatic system.
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Hypoalbuminemia is
associated with liver and renal disease, PET, SIRS including burns, trauma
and surgery.
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Decreased albumin in
adults is a marker of associated disease (a negative acute phase reactant)
not a feature of isolated protein-energy malnutrition. It is a poor
indicator of nutritional status (so too is prealbumin).
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Low serum albumin is an independent indicator of
(poor) outcome in critical illness.
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There is no evidence that
correcting hypoalbuminemia improves outcome, indeed therapeutic albumin
administration may worsen outcome.
References
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Allison SP, Lobo DN.
Debate: Albumin administration should not be avoided. Crit Care 2000;
4(3):147-150.
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Blunt MC, Nicholson JP,
Park GR. Serum albumin and colloid osmotic pressure in survivors and
nonsurvivors of prolonged critical illness. Anaesthesia 1998;
53(8):755-761.
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Boldt J. The good, the
bad, and the ugly: should we completely banish human albumin from our
intensive care units? Anesth Analg 2000; 91(4):887-95, table.
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Bunn F, Lefebvre C, Li
Wan PA, Li L, Roberts I, Schierhout G. Human albumin solution for
resuscitation and volume expansion in critically ill patients. The Albumin
Reviewers. Cochrane Database Syst Rev 2000;(2):CD001208.
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Fischer J. When is an
albumin infusion needed? Dimens Crit Care Nurs 1999; 18(4):17.
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Goldwasser P, Feldman J.
Association of serum albumin and mortality risk. J Clin Epidemiol 1997;
50(6):693-703.
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Judkins K. Burns
resuscitation: what place albumin? Hosp Med 2000; 61(2):116-119.
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Manelli JC. [Is albumin
administration useful in critical care for burnt patients?]. Ann Fr Anesth
Reanim 1996; 15(4):507-513.
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Margarson MP, Soni N.
Serum albumin: touchstone or totem? Anaesthesia 1998; 53(8):789-803.
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Nicholson JP, Wolmarans
MR, Park GR. The role of albumin in critical illness. Br J Anaesth 2000;
85(4):599-610.
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Pulimood TB, Park GR.
Debate: Albumin administration should be avoided in the critically ill.
Crit Care 2000; 4(3):151-155.
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Roberts I, Edwards P,
McLelland B. More on albumin. Use of human albumin in UK fell
substantially when systematic review was published. BMJ 1999;
318(7192):1214-1215.
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Skillman JJ.
Albumin--does the bell toll for thee? Transfusion 1999; 39(2):120-122.
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Soni N. Human albumin
administration in critically ill patients. Validity of review methods must
be assessed. BMJ 1998; 317(7162):883-884.
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Soni N. Wonderful
albumin? BMJ 1995; 310(6984):887-888.
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Stehle G, Wunder A, Heene
DL. Is albumin administration harmful in critically ill patients? The
patient's nitrogen and energy balance may provide an answer. Crit Care Med
2000; 28(5):1697.
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Wilkes MM, Navickis RJ.
Patient survival after human albumin administration. A meta-analysis of
randomized, controlled trials. Ann Intern Med 2001; 135(3):149-164.
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Human albumin
administration in critically ill patients: systematic review of randomised
controlled trials. Cochrane Injuries Group Albumin Reviewers. BMJ 1998;
317(7153):235-240.
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Sort P, Navasa M, Arroyo
V. Effect of intravenous albumin on renal impairment and mortality in
patients with cirrhosis and spontaneous bactrial peritonitis. N Engl J Med
1999; 341(6):403-409.
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