What is the most efficacious albumin dose for large volume paracentesis?

Using an order set to guide albumin dosing based on the amount of ascitic fluid removed during large volume paracentesis (LVP) significantly reduces the amount of albumin given with no difference in adverse effects, reports a study.

This retrospective review evaluated the impact of implementing a standardized LVP order set on albumin use and outcomes in patients with ascites due to cirrhosis who received a therapeutic paracentesis at a large, academic institution. The amount of albumin utilization prior to and after order set implementation was the primary outcome.

Albumin doses were standardized in the order set to the following: 25 g (5–6 L removed), 50 g (7–10 L), and 75 g (>10 L). Patient outcomes included rates of hyponatraemia, renal impairment, and hypotension.

One hundred patients were included in each arm of the final analysis. Patients prior to the implementation of the order set received a higher amount of albumin per litre removed compared to those after the implementation (8.3 vs 6.5 g/L; p<0.01).

No significant between-group differences were seen in absolute changes in serum sodium (0 vs −1 mEq/L; p=0.64), serum creatinine (0.06 vs 0.05 mg/dL; p=0.94), or systolic blood pressure (−4 vs −3 mm Hg; p=0.96). No differences were also observed between groups in terms of rates of hyponatraemia (1.6 percent vs 6.6 percent; p=0.21), renal impairment (911.3 percent vs 11.5 percent; p=0.97), or hypotension (17.4 percent vs 17.6 percent; p=0.97).

“Albumin after LVP reduces paracentesis-induced circulatory dysfunction,” the investigators noted.