Changes in serum albumin concentration and volume expanding effects following a bolus of albumin 20% in septic patients

Background. Patients with systemic sepsis develop a capillaryleak syndrome, and serum –albumin concentration decreases.Hyperoncotic albumin infusion can be used for volume expansionin these patients, but the degree and duration of effect arenot well described. We assessed volume expansion by albumin20% infusion and compared the retention of infused albumin inseptic patients and healthy controls. Methods. We gave albumin 20%, 200 ml as a rapid infusion to70 patients with septic shock and 26 controls. Blood sampleswere taken before and 1, 5, 15, 30, 60, 120 and 240 min afterthe infusion for measurement of serum albumin concentrationand haematocrit. Haemodilution and the percentage of administeredalbumin remaining intravascularly at each time were calculated. Results. The mean proportion of the increase in albumin remainingat 4 h was 68.5 (SD 10)% in septic patients and 79 (5)% in controls(P<0.001). The albumin 20%, 200 ml caused a secondary fluidresorption and volume expansion maximal at 30 min, equivalentto a 430 ml infusion in septic patients and 500 ml in controls. Conclusions. After giving albumin, serum albumin concentrationsdecrease significantly faster in septic patients than in healthycontrols. Br J Anaesth 2004; 92: 821–6