10 Feb 2026
Recent clinical trials and protocols (2024–2025) for managing septic shock use 20% albumin primarily as a second-line therapy when patients remain hypotensive despite initial crystalloid resuscitation (30mL/kg).
Current dosage protocols for 20% albumin in septic shock focus on two main strategies: bolus resuscitation for hemodynamic stability and maintenance to target specific serum albumin levels.
1. Bolus Resuscitation Protocols (Early Shock Reversal)
In the early phases of septic shock, especially in emergency department (ED) settings, high-concentration albumin is given in discrete boluses:
Initial Resuscitation: 200 mL of 20% albumin combined with 15 mL/kg of crystalloid, typically administered over 1–2 hours.
Standard Dosing: 0.5 to 1 g/kg per dose (equivalent to 2.5 to 5 mL/kg of 20% solution).
Cirrhosis and Sepsis-Induced Hypotension: 0.5 to 1.0 g/kg of 20% albumin infused over 3 hours has been used specifically to achieve faster improvement in MAP and lactate clearance.
2. Maintenance and Targeted Albumin Protocols
Recent trials such as ALBIOS and ALBUS emphasize maintaining serum albumin at specific physiological thresholds to improve outcomes:
Maintenance Target: Aiming for a serum albumin level $\ge 3.0\text{ g/dL (30 g/L)}$.
Surgical Septic Shock (ALBUS Protocol): 20% human albumin solution is used to maintain concentrations above 3.5 g/dL for up to 72 hours.
Dosing Adjustments Based on Levels:
Level < 20 g/L: 80 g of 20% albumin over 3–4 hours.
Level 20–25 g/L: 60 g over 2–3 hours.
Level 25–30 g/L: 40 g over 1–2 hours.
Evidence-Based Maintenance: 20 grams every 8 hours for 3 days as an adjuvant to crystalloid resuscitation in hypoalbuminemic patients.
3. Clinical Administration and Safety Limits
Infusion Rate: For hypoalbuminemic patients, the rate should generally not exceed 2 mL per minute to prevent circulatory overload and pulmonary edema. (The UK Sepsis trust Guildeline 2024)
Volume Expansion Effect: 20% albumin is hyperoncotic; 100 mL can expand plasma volume by 3–4 times (approx. 400 mL) within 20–30 minutes by drawing fluid from the interstitial spaces.
Monitoring Requirements: Protocols mandate continuous monitoring for signs of fluid overload (e.g., bilateral crepitations or raised Central Venous Pressure > 15 mmHg).
Dilution Warning: If diluted, only use 0.9% sodium chloride or 5% dextrose; never use water as it causes intravascular hemolysis.
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