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South Australian Neonatal Medication Guidelines 

Albumin  
 Human Albumin 40g/L (Albumex  4%) 
  200g/L (Albumex  20%) 

  Department for Health and Wellbeing, Government of South Australia. All rights reserved.  

INFORMAL COPY WHEN PRINTED  Page 1 of 3 

Public-I4-A1 
 
 

Note:
This guideline provides advice of a general nature.  This statewide guideline has been prepared to promote and facilitate 
standardisation and consistency of practice, using a multidisciplinary approach.  The guideline is based on a review of 
published evidence and expert opinion.  
Information in this statewide guideline is current at the time of publication.  
SA Health does not accept responsibility for the quality or accuracy of material on websites linked from this site and does not 
sponsor, approve or endorse materials on such links. 
Health practitioners in the South Australian public health sector are expected to review specific details of each patient and 
professionally assess the applicability of the relevant guideline to that clinical situation. 
If for good clinical reasons, a decision is made to depart from the guideline, the responsible clinician must document in the 
patient s medical record, the decision made, by whom, and detailed reasons for the departure from the guideline. 
This statewide guideline does not address all the elements of clinical practice and assumes that the individual clinicians are 
responsible for discussing care with consumers in an environment that is culturally appropriate and which enables respectful 
confidential discussion. This includes: 

  The use of interpreter services where necessary, 
  Advising consumers of their choice and ensuring informed consent is obtained, 
  Providing care within scope of practice, meeting all legislative requirements and maintaining standards of 

professional conduct, and  
  Documenting all care in accordance with mandatory and local requirements 

Caution  
There are two strengths of Albumin (human) available, albumin 4% and albumin 20%. 
Incorrect product selection could lead to severe circulatory overload or sudden cardiac 
failure. 

Albumin is a blood product and requires consent before 
administration. Order Albumin through Blood Transfusion Service. 

Synonyms  
Human albumin, normal serum albumin  

Dose and Indications 

Hypoalbuminemia 

Intravenous 

0.5   1g/kg/dose (2.5   5mL/kg/dose of albumin 20%) 

Neonatal hyperbilirubinemia 

Intravenous 

1g/kg/dose (5mL/kg/dose of albumin 20%) administered 30 to 60 minutes prior to exchange 
transfusion for hyperbilirubinemia  

 

 



South Australian Neonatal Medication Guidelines 

Albumin 
 Human Albumin 40g/L(Albumex  4%), 200g/L (Albumex  20%) 
 

 

 
INFORMAL COPY WHEN PRINTED  Page 2 of 3 

Public-I4-A1 
 
 

Hypotension, septic shock 

Hypovolaemia 

Intravenous 

0.4g/kg (10mL/kg/dose of albumin 4%) 

Preparation and Administration 

Intravenous 

Albumin 4% 

Hypotension, septic shock   Infuse over 20 to 30 minutes or as indicated by clinical scenario  

Albumin 20% 

Infuse over a maximum of 4 hours or as prescribed. Caution   too rapid administration can 
result in vascular overload 

&gt; Infuse through a standard IV giving set or blood administration set (with 170-200microg 
filter).  

&gt; Warm to room temperature before administering. 

&gt; Albumin has a clear to pale yellow colour, but may range from amber to green. If solution 
appears cloudy or turbid, do not use.  

&gt; Albumex  does not contain antimicrobial agents so it must be used immediately after 
opening. Use within 4 hours of opening the vial. 

Compatible Fluids 
Glucose 5%, glucose 10%, sodium chloride 0.9%, glucose/sodium chloride solutions 

Albumin is routinely added to laminar flow custom prepared parenteral nutrition solution 
(PNS) in some hospital sterile production facilities. Published stability data are however not 
available. 

Adverse Effects 

Common 

Chills, fever, vomiting, urticaria 

Unknown frequency 

Hypotension, hypertension, rigors, sodium overload, vascular overload causing pulmonary 
oedema, cardiac failure, anaphylaxis/hypersensitivity 

Monitoring 
&gt; Temperature, blood pressure, respiration and heart rate at baseline and during infusion 

&gt; Observe for signs of hypervolemia, pulmonary odema and cardiac failure 



South Australian Neonatal Medication Guidelines 

Albumin 
 Human Albumin 40g/L(Albumex  4%), 200g/L (Albumex  20%) 
 

 

 
INFORMAL COPY WHEN PRINTED  Page 3 of 3 

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Practice Points 
&gt; Albumin 20% may place infant at risk of fluid overload if administered too rapidly or in 

large doses. 

&gt; Incompatible with multiple medications (refer to your pharmacy department for more 
information). 

&gt; Albumin infusions do not confer any advantage over crystalloid in the acute treatment of 
hypovolaemia. Isotonic crystalloid solutions are recommended for initial volume 
expansion.  

&gt; Albumin contains trace amounts of aluminium and administration of large volumes may 
lead to accumulation and toxicity in renally impaired patients. 

&gt; Where the 4% strength may not be available, the 20% albumin may be diluted to 4% with 
compatible fluid. 

&gt; See local guidelines for site specific handling and administration procedures. 

&gt; Adhere to site policy for recording use of plasma products (e.g. batch numbers) 

&gt; Limited evidence suggests that bioavailability of albumin in PNS is not affected by 0.2 
micron bacterial filters. 

References 
&gt; Prosser AE, Wynne SB, Morris SA, Grzeskowiak LE, Filterability of human serum albumin 

in parenteral nutrition administered to neonates though an in-line 0.2micron filter, 2017, 
Journal of Pharmacy Practice and Research, The Society of Hospital Pharmacists of 
Australia, 47, 494-496 

 
Document Ownership &amp; History 

Developed by: SA Maternal, Neonatal &amp; Gynaecology Community of Practice 
Contact: Health.NeoMed@sa.gov.au 
Endorsed by:  SA Health Safety and Quality Strategic Governance Committee 
Next review due:  16/05/2024 
ISBN number:  978-1-76083-059-5 
PDS reference:  CG304 
Policy history: Is this a new policy (V1)?  N 
 Does this policy amend or update and existing policy?   Y 
 If so, which version? V1 
 Does this policy replace another policy with a different title?  N 
 If so, which policy (title)?  
 

Approval 
Date Version 

Who approved New/Revised 
Version Reason for Change 

16/05/2019 V1.1 SA Health Safety and Quality Strategic 
Governance Committee 

Minor amendment to administration and 
additional practice point 

12/02/2019 V1 SA Health Safety and Quality Strategic 
Governance Committee 

Original SA Health Safety and Quality 
Strategic Governance Committee approved 
version 

 



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