Albumin accounts for about 50 percent of the circulating protein and 75 percent of the plasma oncotic pressure. Albumin replacement products are available as 5% or 25% solutions in saline. Plasma protein fraction (PPF) is a similar product; it is a 5% solution containing 88 percent albumin and 12 percent globulins. These products undergo heat inactivation for 10 h at 60°C and are not known to transmit viral diseases.

The clinical indications for albumin infusion are controversial but may include the following:

1. As colloid replacement to replace or maintain oncotic pressure. Most clinical experimental studies suggest that there is no advantage to colloid solutions over crystalloid in the acute management of hemorrhagic shock. Infused albumin solutions rapidly distribute to the extravascular space and are expensive.

2. In conjunction with large volume paracentesis in patients with refractory ascites.

3. In patients with severe burns. Most centers are moving away from this practice.

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