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BJA Advance Access published online on April 2, 2004
British Journal of Anaesthesia, doi:10.1093/bja/aeh111
© 2004 by The Board of Management and Trustees of the British Journal of Anaesthesia
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Accepted December 12, 2003

Clinical Investigation

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

M. P. Margarson 1* N. C. Soni 1

1 Imperial College School of Science, Technology and Medicine, Magill Department of Anaesthesia, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK

* To whom correspondence should be addressed. E-mail: m.margarson{at}ic.ac.uk.


  Abstract

Background. Patients with systemic sepsis develop a capillary leak syndrome, and serum -albumin concentration decreases. Hyperoncotic albumin infusion can be used for volume expansion in these patients, but the degree and duration of effect are not well described. We assessed volume expansion by albumin 20% infusion and compared the retention of infused albumin in septic patients and healthy controls.

Methods. We gave albumin 20%, 200 ml as a rapid infusion to 70 patients with septic shock and 26 controls. Blood samples were taken before and 1, 5, 15, 30, 60, 120 and 240 min after the infusion for measurement of serum albumin concentration and haematocrit. Haemodilution and the percentage of administered albumin remaining intravascularly at each time were calculated.

Results. The mean proportion of the increase in albumin remaining at 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 fluid resorption and volume expansion maximal at 30 min, equivalent to a 430 ml infusion in septic patients and 500 ml in controls.

Conclusions. After giving albumin, serum albumin concentrations decrease significantly faster in septic patients than in healthy controls.

Keywords: Keywords: blood, haemodilution; blood, volume expansion; complications, capillary leak; complications, sepsis; protein, albumin


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