Albumin 25% (hyper-oncotic)
Albuminar 25% · Plasbumin 25%
Hyper-oncotic human serum albumin colloid
5× more concentrated than 5% albumin. Hyper-oncotic — pulls interstitial fluid into the intravascular space. 100 mL of 25% albumin can expand plasma volume by 400–500 mL by drawing fluid across the capillary membrane.
Indications
- •Hypoalbuminemia with edema where rapid intravascular volume expansion is desired without large-volume infusion
- •Cerebral edema (with diuretic — older protocols)
- •Refractory ascites with low albumin
- •Burn resuscitation in late phase (>24 h post-burn) when capillary leak resolves
- •Therapeutic plasmapheresis replacement
Dosing
| Context | Adult | Pediatric |
|---|---|---|
| Volume expansion / oncotic | 12.5–25 g IV (50–100 mL) — slow infusion | — |
| Plasmapheresis replacement | Per session, calculated to replace plasma volume removed | — |
Pharmacokinetics
Intravascular half-life 16 h; effective volume expansion lasts 4–6 h until equilibration.
Hemodynamic effects
Rapid intravascular volume expansion — risk of pulmonary edema and CHF exacerbation if cardiac function impaired.
Respiratory effects
Pulmonary edema risk if rapid bolus into volume-restricted patient with poor LV function.
Side effects
- !Volume overload (greater risk than 5% albumin given the expansion ratio)
- !Pulmonary edema
- !Hypotension during rapid infusion
- !Allergic reactions (rare)
Contraindications
- ×Severe anemia
- ×Cardiac failure with volume restriction
- ×Hypersensitivity
Clinical pearls
- ★VOLUME MATH: 100 mL of 25% albumin → 400–500 mL plasma volume expansion. Useful in CHF or pulmonary-edema-prone patients where you need preload but cannot tolerate large infused volumes.
- ★DEHYDRATED PATIENT WARNING: 25% albumin pulls fluid OUT of the interstitium — gives temporary plasma expansion but worsens total-body dehydration. Pair with crystalloid replacement when total-body water is low.
- ★OB HEMORRHAGE: not first-line. Crystalloid + blood products are. 25% albumin has a niche in volume-restricted edematous patients.
- ★PLASMAPHERESIS: 5% albumin is standard replacement; 25% used as concentrated source in volume-overloaded patients only.
- ★PATIENTS WITH 'LOW ALBUMIN' ON LABS: do NOT correct lab albumin with 25% albumin — no mortality benefit, expensive, and lab levels return to baseline within hours. Reserve for the specific indications above.
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Other drugs in Colloids
- Albumin 5% (iso-oncotic)
Heat-treated, pasteurized human serum albumin in 0.9% NaCl at 5% concentration. Iso-oncotic with normal plasma — expands intravascular volume approximately 1:1 with infused volume by maintaining colloid oncotic pressure.
- Hydroxyethyl Starch (HES) — generally avoided in 2026
Polymer of hydroxyethylated glucose units derived from waxy maize. Provides oncotic volume expansion similar to albumin. Higher-molecular-weight / higher-substitution products (Hespan) cause more renal dysfunction than lower-substitution products (Voluven), but both have been shown harmful in critical illness.
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