Questions and Answers
What is the current consideration of albumin use in clinical practice?
Not considered mandatory and its use is questioned
What is the recommended initial therapy for patients with septic shock according to the Surviving Sepsis Campaign guidelines?
Rapid administration of 30 mL/kg of crystalloid solution
What is the effect of administering albumin on plasma volume?
It increases the plasma volume, with a decrease in the plasma volume expansion as a function of the dose administered
What is the approximate residual time of human albumin in circulation?
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What is the daily turnover of human albumin in the body?
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What is a potential pleiotropic effect of human albumin?
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What is the benefit of using albumin in subarachnoid hemorrhage patients?
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What is an advantage of human albumin over other plasma expanders?
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What is the primary role of albumin in maintaining hemodynamic stability?
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What is the common indicator of hypovolemic shock?
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What is the primary mechanism by which albumin enhances oncotic pressure?
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What is the consequence of a decrease in the serum albumin concentration?
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What is the therapeutic effect of albumin substitution in cirrhosis patients?
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What is the definition of hemodynamically stable patients?
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What is the suggested hemodynamic target for albumin treatment?
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What is the relationship between the shock index and mortality?
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What is the primary benefit of albumin administration in patients with trauma?
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What is the role of albumin in regulating the intravascular volume?
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Study Notes
Human Albumin Administration in Clinical Practice
- The use of albumin in clinical practice is not considered mandatory, and its use in septic shock has been called into question by various studies.
- The Surviving Sepsis Campaign guidelines recommend reducing the use of albumin as the fluid of choice in case of non-availability of crystalloids.
- Human albumin is often prescribed for the treatment of hypoalbuminemia and its potential clinical advantages.
Clinical Advantages of Human Albumin
- It is the only plasma expander that has been shown to exert a plasma volume expanding effect, with a decrease in the plasma volume expansion as a function of the dose administered.
- It possesses a long residual time in circulation (approximately 20 days) with a daily turnover of about 10%, mainly through catabolism in the liver.
- Its easy handling and the availability of a presentation not requiring dilution are also reported.
Improved Hemodynamic Stability
- Patients with albumin replacement show less shock index (ratio of pulse to SBP) and faster resolution of the hyperdynamic phase.
- Hemodynamically stable patients are defined as having a SBP greater than 90 mmHg, heart rate of less than 100 bpm, urine output of greater than 30 mL/hr, clear mental status, and a warm extremity with palpable pulses.
- A suggested hemodynamic target would be mean arterial pressure of about 85–90 mmHg.
Enhanced Oncotic Pressure
- Albumin can efficiently enhance oncotic force and avoid or even reduce the incidence of edema after surgery, improve hypoalbuminemia in cirrhosis patients, and avoid the management of ascites.
- The oncotic property of albumin, which is modulated by the colloid osmotic pressure that it generates, draws water from the interstitium into the intravascular space.
- The contribution of a large protein like albumin to plasma oncotic pressure is obviously beneficial when a decrease in the serum albumin concentration is compensated by the administration of HSA.
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Description
Explore the benefits of using human albumin in clinical practice, particularly in septic shock treatment, despite controversies and debates.