As a general rule, the serum albumin concentration should be raised to at least 2 g/dl with fresh frozen plasma or HSA. Administering
fresh frozen plasma can help restore some of the intravascular albumin, but it is largely inefficient on a ml/kg basis when
compared with HSA. Plasma is better suited to replenish clotting factors and antithrombin and should be used in conjunction
with a synthetic colloid such as hetastarch to maintain oncotic pressure. A volume of 20 ml/kg plasma will raise the serum
albumin concentration by 0.5 g/dl, provided no ongoing protein loss is present.11
Chronic hypoalbuminemia results when the body's interstitial albumin pool becomes depleted and can no longer maintain intravascular
albumin concentrations and oncotic pressure. The albumin contained in an infusion of fresh frozen plasma will replenish the
interstitial albumin stores before an increase in serum albumin is detected. But in many cases, this can be costly and can
deplete a hospital's resources of plasma. Instead, a more efficient means of restoring both interstitial and intravascular
albumin is to administer HSA.
HSA has been used with success in a variety of critically ill dogs.12 It is a potent colloid and is effective in restoring serum and interstitial albumin in patients with acute or chronic hypoalbuminemia
for the short term, but in animals with chronic hypoalbuminemia, the underlying cause of decreased albumin production or increased
loss must also be addressed for the best long-term outcome.
HSA also helps retain fluid within the vascular space.11 Like other colloids, HSA can also pull fluid from the interstitium into the vascular space, so it may be helpful in treating
interstitial edema. Carefully monitor the animal for signs of intravascular volume overload such as tachypnea, orthopnea,
chemosis, or fulminant pulmonary edema.
Pretreat animals with 1 mg/kg intramuscular diphenhydramine, and then give 2 ml/kg HSA over four hours. Monitor for clinical
signs of a reaction, including urticaria, angioneurotic edema, hypotension, salivation, and vomiting. Rare reports of delayed
reactions and systemic vasculitis and polyarthritis have been observed in dogs about 14 days after albumin infusion.13 All patients had clinical signs of gastrointestinal inflammation or septic peritonitis at the time of albumin infusion.
Treat vasculitis and polyarthritis with 1 mg/kg prednisone given orally twice a day for two weeks and then tapered over two
additional weeks. Although the potential for a reaction exists, the benefits of albumin supplementation can outweigh this
small risk and can improve overall outcome.
CONCLUSION
Intravenous fluid therapy is undoubtedly one of the mainstays of treatment of both acute and chronic illnesses. The fluid
armamentarium available to veterinary practitioners has evolved dramatically over the past decades to include a variety of
crystalloid and colloidal fluids. Similar to choosing an antibiotic to treat the most likely bacterial infection, a fluid
should be chosen to treat a specific disease entity. Even in situations in which a specific diagnosis has not yet been made,
the fluid should be chosen after careful consideration of an animal's acid-base, electrolyte, dehydration, and oncotic pressure
status. It is not necessary to stock every crystalloid or colloid available. However, having a combination of replacement
and maintenance crystalloids along with a colloid to choose from can decrease morbidity and mortality in your most critically
ill patients.
Elisa M. Mazzaferro, MS, DVM, PhD, DACVECC
Wheat Ridge Veterinary Specialists
3695 Kipling St.
Wheat Ridge, CO 80033
This article is adapted from Dr. Mazzaferro's 2006 CVC East proceedings paper.
|
Featuring Information from:
