Indications for Albumin after Paracentesis

2009 AASLD Guidelines recommend albumin replacement after large volume paracenteses if > 4-5 L are removed; 6-8 g/L of albumin (25% concentration) should be given.

So, for example, if 10 liters are removed, you would give 60-80 grams of 25% albumin.

Although no trial has demonstrated any survival benefit from albumin replacement after large volume tap, it does help prevent asymptomatic laboratory abnormalities, some of which are associated with shortened survival.   For example, in one RCT published in 1988 in Gastroenterology, paracentesis without albumin was associated with increases in plasma renin, aldosterone, and BUN, and decrease in sodium (whereas those who got albumin replacement did not have these abnormalities).

(Chanu Rhee MD, 4/14/11)