2. CLINICAL PHARMACOLOGY13,17
2.1 AlbuRx® 25, Albumin (Human) 25% solution should not be used as an intravenous nutrient because of the slow breakdown and relatively unfavorable composition of the albumin molecule with respect to its content of essential amino acids. Oral provision of proteins or an intravenous regimen providing adequate calories and a suitable amino acid mixture are the methods of choice for the treatment of protein malnutrition as such, though they do not permit the rapid correction of hypoproteinemia.
2.2 The binding properties of albumin may provide an indication for its use in severe hemolytic disease of the newborn, where it may lower the plasma concentration of free bilirubin pending an exchange transfusion. This effect is possibly also relevant in certain cases of acute liver failure with rapidly increasing levels of serum bilirubin, particularly in the presence of severe hypoproteinemia.
2.3 The colloid osmotic or oncotic properties of albumin at this moment constitute the predominant reason for its clinical use. The rationale for this is the Starling concept of the capillary balance of hydrostatic and oncotic pressure gradients across the capillary walls as the determinant of the fluid – i.e. volume – distribution between the intravascular and the interstitial compartment.16 The two main indications for the use of AlbuRx® 25, Albumin (Human) 25% solution are therefore a plasma or blood volume deficit and the oncotic deficit resulting from hypoproteinemia. The 25% concentration is oncotically equivalent to approximately five times its volume of normal human plasma. The effective colloid osmotic pressure of the serum proteins depends very largely on the relatively small and numerous albumin molecules, which therefore play a decisive role in the maintenance of the circulating plasma volume.