Albumin levels in acute or chronic illness goes down due to blocking of transcription by interleukin's and TNF-alpha. Some belief the reason is - bacteria uses it to transport itself to different places and some belief it is as bacteria feeds on it.
so in these conditions patients oncotic pressure is low and they third space. Theoretically you can give 25% albumin and increse the oncotic pressure which will bring the fluid back to intravascular space and then give diuretics. Does it really work - do we have a good data to support it ?
ss
To my knowledge there are only pediatric studies looking at the issue, few open-label studies (zero placebo-controlled) The studies were done in underfill state induced by severe nephrotic syndrome with good diuretic response but only short term. Overfill states like CHF, Cirrhosis, and GN should not be given albumin as there are no salt poor albumin preparations available. Adult trials are truly poorer quality and is generally UF with HD is recommended if the patient has failed maximal diuretic therapy of DOSE trial.
Sandeep Sharma