Buminate 25% (Albumin) - Indications and Dosage

INDICATIONS AND USAGE

1. Hypovolemia
   Hypovolemia is a possible indication for BUMINATE 25%, Albumin (Human), 25% Solution. Its effectiveness in reversing hypovolemia depends largely upon its ability to draw interstitial fluid into the circulation. It is most effective with patients who are well hydrated.
   When hypovolemia is long standing and hypoalbuminemia exists accompanied by adequate hydration or edema, 25% albumin is preferable to 5% protein solutions. ^4,6 However, in the absence of adequate or excessive hydration, 5% protein solutions should be used or 25% albumin should be diluted with crystalloid.
   Although crystalloid solutions and colloid-containing plasma substitutes can be used in emergency treatment of shock, Albumin (Human) has a prolonged intravascular half-life.⁹ When blood volume deficit is the result of hemorrhage, compatible red blood cells or whole blood should be administered as quickly as possible.
2. Hypoalbuminemia
   
   1. General
      Hypoalbuminemia is another possible indication for use of BUMINATE 25%, Albumin (Human), 25% Solution. Hypoalbuminemia can result from one or more of the following: ⁵
      
      1. Inadequate production (malnutrition, burns, major injury, infections, etc.)
      2. Excessive catabolism (burns, major injury, pancreatitis, etc.)
      3. Loss from the body (hemorrhage, excessive renal excretion, burn exudates, etc.)
      4. Redistribution within the body (major surgery, various inflammatory conditions, etc.)
      
      When albumin deficit is the result of excessive protein loss, the effect of administration of albumin will be temporary unless the underlying disorder is reversed. In most cases, increased nutritional replacement of amino acids and/or protein with concurrent treatment of the underlying disorder will restore normal plasma albumin levels more effectively than albumin solutions. Occasionally hypoalbuminemia accompanying severe injuries, infections or pancreatitis cannot be quickly reversed and nutritional supplements may fail to restore serum albumin levels. In these cases, BUMINATE 25%, Albumin (Human), 25% Solution might be a useful therapeutic adjunct.
   2. Burns
      An optimum regimen for the use of albumin, electrolytes and fluid in the early treatment of burns has not been established, however, in conjunction with appropriate crystalloid therapy, BUMINATE 25%, Albumin (Human), 25% Solution may be indicated for treatment of oncotic deficits after the initial 24 hour period following extensive burns and to replace the protein loss which accompanies any severe burn.^4,6
   3. Adult Respiratory Distress Syndrome (ARDS)
      A characteristic of ARDS is a hypoproteinemic state which may be causally related to the interstitial pulmonary edema. Although uncertainty exists concerning the precise indication of albumin infusion in these patients, if there is a pulmonary overload accompanied by hypoalbuminemia, 25% albumin solution may have a therapeutic effect when used with a diuretic.⁴
   4. Nephrosis
      BUMINATE 25%, Albumin (Human), 25% Solution may be a useful aid in treating edema in patients with severe nephrosis who are receiving steroids and/or diuretics.
3. Cardiopulmonary Bypass Surgery
   BUMINATE 25%, Albumin (Human), 25% Solution has been recommended prior to or during cardiopulmonary bypass surgery, although no clear data exist indicating its advantage over crystalloid solutions. ^4,6,10
4. Hemolytic Disease of the Newborn (HDN)
   BUMINATE 25%, Albumin (Human), 25% Solution may be administered in an attempt to bind and detoxify unconjugated bilirubin in infants with severe HDN.

There is no valid reason for use of albumin as an intravenous nutrient.

DOSAGE AND ADMINISTRATION

BUMINATE 25%, Albumin (Human), 25% Solution must be administered intravenously. This solution may be administered in conjunction with or combined with other parenterals such as whole blood, plasma, saline, glucose or sodium lactate. The addition of four volumes of normal saline or 5% glucose to 1 volume of BUMINATE 25%, Albumin (Human), 25% Solution gives a solution which is approximately isotonic and isosmotic with citrated plasma.

Albumin solutions should not be mixed with protein hydrolysates or solutions containing alcohol.

RECOMMENDED DOSAGES

1. Hypovolemic Shock
   The dosage of BUMINATE 25%, Albumin (Human), 25% Solution must be individualized. As a guideline, the initial treatment should be in the range of 100 to 200 mL for adults and 2.5 to 5 mL per kilogram body weight for children. This may be repeated after 15 to 30 minutes, if the response is not adequate. For patients with significant plasma volume deficits, albumin replacement is best administered in the form of 5% Albumin (Human).
   Upon administration of additional albumin or if hemorrhage has occurred, hemodilution and a relative anemia will follow. This condition should be controlled by the supplemental administration of compatible red blood cells or compatible whole blood.
2. Burns
   The optimal therapeutic regimen for administration of crystalloid and colloid solutions after extensive burns has not been established. When BUMINATE 25%, Albumin (Human), 25% Solution is administered after the first 24 hours following burns, the dose should be determined according to the patient's condition and response to treatment.
3. Hypoalbuminemia
   Hypoalbuminemia is usually accompanied by a hidden extravascular albumin deficiency of equal magnitude. This total body albumin deficit must be considered when determining the amount of albumin necessary to reverse the hypoalbuminemia. When using patient's serum albumin concentration to estimate the deficit, the body albumin compartment should be calculated to be 80 to 100 mL per kg of body weight.^5,6 Daily dose should not exceed 2 g of albumin per kilogram of body weight.
4. Hemolytic Disease of the Newborn
   BUMINATE 25%, Albumin (Human), 25% Solution may be administered prior to or during exchange transfusion in a dose of 1 g per kilogram body weight.¹¹

PREPARATION FOR ADMINISTRATION

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.

1. Remove cap from bottle to expose center portion of rubber stopper.
2. Clean stopper with germicidal solution.

ADMINISTRATION

Follow directions for use printed on the administration set container. Make certain that the administration set contains an adequate filter.

HOW SUPPLIED

BUMINATE 25%, Albumin (Human), 25% Solution is supplied in 20 mL, 50 mL and 100 mL bottles.

STORAGE

Store BUMINATE 25%, Albumin (Human), 25% Solution at room temperature, not to exceed 30°C (86°F). Avoid freezing to prevent damage to the bottle.