How albumin administration for cirrhosis impacts on hospital albumin consumption and expenditure

Table 2 Practical recommendations for the prescription of albumin at the S Orsola-Malpighi University Hospital, Bologna, Italy

Acute diseases	First-line treatment	Second-line treatment
Hypovolemic shock [1, A]	Colloid/crystalloid solutions	Human albumin if:
		Sodium intake restriction
		Hypersensitivity to colloids or crystalloids
		Lack of response to combined use of colloids and crystalloids
Major surgery [6, C]
(1) Cardiovascular surgery	Colloid/crystalloid solutions	Human albumin if:
		Lack of response to combined use of colloids and crystalloids
		As for hypovolemic shock
(2) Other surgery	As for hypovolemic shock
Burns [6, C]	Colloid/crystalloid solutions	Human albumin plus crystalloid solutions if:
		Lack of response to colloid or crystalloid solutions alone
		Severe burns (> 50% body surface)
Chronic diseases	First-line treatment	Second-line treatment
Cirrhosis	Human albumin
(1) Paracentesis [1, A]	8 g/L of removed ascites if paracentesis > 4 L
(2) Spontaneous bacterial peritonitis [1, A]	1.5 g/kg at diagnosis and 1 g/kg on third day + antibiotic therapy
(3) Hepatorenal syndrome [1, A]	1 g/kg at diagnosis followed by 20-40 g/d + vasoconstrictors
(4) Ascites [1, A]	Diuretic treatment	Human albumin if: Ascites resistant to diuretics
Plasmapheresis [6, C]	Human albumin if plasma changes > 20 mL/kg per week
Protein wasting enteropathy/malnutrition	Enteral or parenteral nutrition	Human albumin only if:
		severe diarrhea (> 2 L/d)
		albuminemia < 2 g/dL
		clinical hypovolemia

Albumin is not recommended for cerebral ischemia (3, B), wound-healing (6, C), chronic pancreatitis (6, C), nephritic syndrome (6, C). Albumin is also provided for the following specific procedures: pulmonary endarterectomy, molecular adsorbent recirculating system (MARS), immunomagnetic selection system (CLINIMACS).