Chloride and Other Electrolyte Concentrations in Commonly Available 5% Albumin Products

Lai, Alison T.; Zeller, Michelle P.; Millen, Tina; Kavsak, Peter A.; Szczeklik, Wojciech; Elahie, Allahna; Alhazzani, Waleed; D’Aragon, Frédérick; Jaeschke, Roman; Lamontagne, François; Karachi, Timothy; Cook, Deborah J.; Meade, Maureen O.

doi:10.1097/ccm.0000000000002955

Cited by 9 publications

(8 citation statements)

References 6 publications

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“…Moreover, albumin may provide volume expansion with less significant chloride burden when compared with both isotonic saline and balanced crystalloid solutions 17,27 . Indeed, albumin is often prepared in normal saline, with chloride concentrations 109–140 mmol/L 50 . Despite supraphysiologic levels of chloride found in some albumin solutions, the chloride load remains of less clinical significance when compared with volume expansion with crystalloid 22,50–52 .…”

Section: Resultsmentioning

confidence: 99%

“…Indeed, albumin is often prepared in normal saline, with chloride concentrations 109–140 mmol/L 50 . Despite supraphysiologic levels of chloride found in some albumin solutions, the chloride load remains of less clinical significance when compared with volume expansion with crystalloid 22,50–52 . This distinction is derived from multiple studies that indicate that larger volumes of crystalloids are needed to create similar changes in hemodynamic parameters, when compared with resuscitation with albumin 22,51,52 .…”

Section: Resultsmentioning

confidence: 99%

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Postoperative resuscitation with hypertonic saline or hyperoncotic albumin in patients following cardiac surgery: A review of the literature

Otero

Aljure

2020

J Card Surg

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Background Over‐resuscitation in postcardiac surgery patients is associated with significant morbidity and mortality. Accordingly, there is a growing interest in hyperoncotic albumin and hypertonic saline for resuscitation in patients following cardiac surgery. In this article, we will review the use of hyperosmolar fluid therapies for resuscitation in postcardiac surgical patients from the current literature. Methods A literature search was conducted in MEDLINE (PubMed) utilizing keywords, narrowing publications from 2009 to 2020. Results Patients receiving concentrated albumin after cardiac surgery required less fluid bolus therapy, less time on vasopressors, and had a lower positive fluid balance compared with patients receiving crystalloids. There was no difference in mortality in those given 20% albumin compared with crystalloids postcardiac surgery. Patients administered hypertonic saline following cardiac surgery had increased urinary output but its effect on total fluid and body weight was not significantly different compared with crystalloids. Conclusions In this analysis, publications on resuscitation with hyperoncotic albumin and hypertonic saline in patients following cardiac surgery were reviewed. While there is data supporting the use of alternative fluid therapies in other critically ill populations, the limited literature focused on concentrated albumin and hypertonic saline for resuscitation following cardiac surgery is equivocal.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Postoperative resuscitation with hypertonic saline or hyperoncotic albumin in patients following cardiac surgery: A review of the literature

Otero

Aljure

2020

J Card Surg

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“…15,30 Chloride concentration also varies significantly between each commercial albumin preparation. 31 For the most part, most 5% human albumin solutions are approximately iso-oncotic and isotonic to human plasma (Table 1). 15,30,32…”

Section: Commercial Preparations Of Albuminmentioning

confidence: 99%

“…5% albumin solution contains ∼145 mEq/L of sodium, although this can vary from 130 to 160 mEq/L, even among solutions produced by the same manufacturer, depending on the volume of diluting solutions and additives used 15,30. Chloride concentration also varies significantly between each commercial albumin preparation 31. For the most part, most 5% human albumin solutions are approximately iso-oncotic and isotonic to human plasma (Table 1).…”

Section: Commercial Preparations Of Albuminmentioning

confidence: 99%

Albumin Use in Brain-injured and Neurosurgical Patients: Concepts, Indications, and Controversies

Kan

Bebawy

2020

Journal of Neurosurgical Anesthesiology

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Human albumin has been used extensively for decades as a nonwhole blood plasma replacement fluid in the perioperative and critical care setting. Its potential advantages as a highly effective volume expander must be weighed, however, against its potential harm for patients in the context of various neurological states and for various neurosurgical interventions. This narrative review explores the physiological considerations of intravenous human albumin as a replacement fluid and examines the extant clinical evidence for and against its use within the various facets of modern neuroanesthesia and neurocritical care practice.

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“…In addition, given the raised potential adverse impact of high chloride fluid infusion, concerns as to variable chloride contents in different commercial Alb products have recently been reported [ 55 ], and it is noteworthy in this context that in turn increasing albuminemia may decrease pH due to a higher anion gap [ 56 ].…”

Section: Fluid Resuscitation: Should We Do More or Less With What Anmentioning

confidence: 99%

Hemodynamic support in the early phase of septic shock: a review of challenges and unanswered questions

Lesur

Delile

Asfar

et al. 2018

Ann. Intensive Care

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BackgroundImproving sepsis support is one of the three pillars of a 2017 resolution according to the World Health Organization (WHO). Septic shock is indeed a burden issue in the intensive care units. Hemodynamic stabilization is a cornerstone element in the bundle of supportive treatments recommended in the Surviving Sepsis Campaign (SSC) consecutive biannual reports.Main bodyThe “Pandera’s box” of septic shock hemodynamics is an eternal debate, however, with permanent contentious issues. Fluid resuscitation is a prerequisite intervention for sepsis rescue, but selection, modalities, dosage as well as duration are subject to discussion while too much fluid is associated with worsen outcome, vasopressors often need to be early introduced in addition, and catecholamines have long been recommended first in the management of septic shock. However, not all patients respond positively and controversy surrounding the efficacy-to-safety profile of catecholamines has come out. Preservation of the macrocirculation through a “best” mean arterial pressure target is the actual priority but is still contentious. Microcirculation recruitment is a novel goal to be achieved but is claiming more knowledge and monitoring standardization. Protection of the cardio-renal axis, which is prevalently injured during septic shock, is also an unavoidable objective. Several promising alternative or additive drug supporting avenues are emerging, trending toward catecholamine’s sparing or even “decatecholaminization.” Topics to be specifically addressed in this review are: (1) mean arterial pressure targeting, (2) fluid resuscitation, and (3) hemodynamic drug support.ConclusionImproving assessment and means for rescuing hemodynamics in early septic shock is still a work in progress. Indeed, the bigger the unresolved questions, the lower the quality of evidence.

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Chloride and Other Electrolyte Concentrations in Commonly Available 5% Albumin Products

Cited by 9 publications

References 6 publications

Postoperative resuscitation with hypertonic saline or hyperoncotic albumin in patients following cardiac surgery: A review of the literature

Postoperative resuscitation with hypertonic saline or hyperoncotic albumin in patients following cardiac surgery: A review of the literature

Albumin Use in Brain-injured and Neurosurgical Patients: Concepts, Indications, and Controversies

Hemodynamic support in the early phase of septic shock: a review of challenges and unanswered questions

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