What exactly are the indications for giving albumin in NS. I looked online and have found conflicting info. Plus I noticed that in the UWorld CCS read out case, they gave albumin (plus lasix). Not sure why albumin was used in that case? or when to use it generally?
I belive unstable orthostatic vitals, signs of dehydration and pleural effusions are indications for albumin infusion. Correct me if I am wrong
Well you are right in a sense but it seems to be a grey area. Some say to use if there is severe proteinuria and hypoalbuminemia which leads to edema and orthstatic hypo.
Some say dont give because problem is in the kidney because as soon as you give the albumin it will stil be lost thru the kidneys.
Still confused
I agree, but I think albumin in the setting of nephrotic may pull the fluid from the 3rd space and alleviate the dehydration/unstable orthostasis. Another controversy that I have is paracenthesis in neprhotic syndrome. I think we only need to tap if there is fever or abdominal pain, suggestive of SBP otherwise we shoud treat it medically and avoid paracethesis. Of course, levaquin po can be given prophlyactically. What do you thik re paracenthesis?
According to Archer:
- If orthstatic hypotension + dehydration --> albumin Rx only
- If fluid overload (anasarca, plerual effusion) --> albumin + lasix
Hi Jasonla, regarding paracentesis I willl only do it if there are signs of SBP. No need to tap for ascites without infection because it will likely reaccumulate.
Another reason to tap may be severe ascites massive enough to compromise respiration. In that case I'm assuming tapping to enhance breathing will be justified but I have no source for this - just logical thinking