The role of albumin replacement in the critically ill veterinary patient

Abstract

Objective: To review the human and veterinary literature on the physiological role and effects of therapeutic albumin supplementation. Data sources: Data from human and veterinary literature was reviewed. Human data synthesis: Hypoalbuminemia often occurs in a variety of critical illnesses, and contributes to the development of life-threatening complications, including pulmonary edema, delayed wound healing, feeding intolerance, hypercoaguability, and multiple organ dysfunction. Serum albumin concentration has been used as a prognostic indicator in cases of chronic hypoalbuminemia. The use of albumin replacement therapy in humans is sometimes controversial, but may be associated with improved morbidity and decreased mortality. Veterinary data synthesis: Unlike human literature, there is a paucity of controlled clinical studies in the literature regarding albumin supplementation in veterinary patients. Rather, the majority of published studies were performed in experimental animals or via retrospective analyses. One recent study evaluated the use of plasma to improve albumin concentration in dogs with hypoalbuminemia. Other older studies investigated wound healing in dogs with experimentally induced hypoalbuminemia. As in human medicine, serum albumin concentration may be helpful as a prognostic indicator in critically ill dogs. Conclusion: Albumin is one of the most important proteins in the body because of its role in maintenance of colloid oncotic pressure, substrate transport, buffering capacity, as a mediator of coagulation and wound healing, and free-radical scavenging. Albumin replacement in veterinary medicine is difficult, but until prospective clinical trials determine the efficacy of albumin replacement are conducted, a suggested clinical guideline would be to maintain albumin concentration at or above 2.0 g/dl utilizing fresh frozen plasma.

Anesthesia in The Critically Ill Patient

“…4 The use of 25% human serum albumin has recently been implemented in veterinary medicine, but adverse effects such as polyarthritis, future transfusion reaction, glomerulonephritis, and other immune-mediated effects warrant cautious use. Unfortunately, size, dosing, and cost become a limiting factor in the use of FFP to treat hypoalbuminemia in larger patients because it takes a dose on the order of 45 ml/kg of FFP to increase the albumin level by 1 g/dl.…”

Administration of Biological Products

“…Additionally, serum albumin concentration is inversely related to mortality in both human and veterinary patients. [27][28][29] Despite the well-documented detrimental effects of hypoalbuminemia, the merits of albumin transfusion in critically ill patients remain unclear. Studies evaluating Transfusion must be completed within 6 hours or discard remainder of blood itoring are paramount to safe administration of HA.…”

Impaired Intestinal Absorption of Glucose in 4 Foals withLawsonia intracellularisInfection

“…As partial small intestinal malabsorption of glucose was documented for prolonged periods of time in the cases here, it also is possible that absorption of other nutrients necessary for protein synthesis may have been impaired resulting in hampered production of albumin and other proteins. 22,23 Furthermore, serum albumin concentration represents 30-40% of total body albumin; the remaining 60-70% is present in extravascular sites such as skin, muscle, liver, lung, heart, kidneys, and spleen. 23,24 During albumin loss the intra-and extravascular albumin pools equilibrate until the extravascular supply is depleted.…”

“…22,23 Furthermore, serum albumin concentration represents 30-40% of total body albumin; the remaining 60-70% is present in extravascular sites such as skin, muscle, liver, lung, heart, kidneys, and spleen. 23,24 During albumin loss the intra-and extravascular albumin pools equilibrate until the extravascular supply is depleted. 23,24 Upon recovery from disease, extravascular albumin must be replenished, thus prolonging recovery of serum albumin concentrations.…”

“…23,24 During albumin loss the intra-and extravascular albumin pools equilibrate until the extravascular supply is depleted. 23,24 Upon recovery from disease, extravascular albumin must be replenished, thus prolonging recovery of serum albumin concentrations. The albumin concentration in foal 1 was below reference limits on day 58, whereas total protein concentration was within normal limits.…”