Let’s go deeper as to why we do what we do: albumin in spontaneous bacterial peritonitis (SBP)!

Time Stamps

• 1:45 How much albumin is recommended in SBP?
• 2:30 What antibiotics are used for treatment of SBP?
• 4:15 Why do we give albumin in SBP?
  • 7:15 How does albumin compare to crystalloid?
  • 9:00 Do we always have to give to albumin?

Show Notes

• Third generation cephalosporins are the mainstay treatment in Spontaneous Bacterial Peritonitis (SBP). Further attempts change antibiotic frequency and duration have failed to show improvements in mortality in patients with SBP.
• Hepatorenal syndrome worsens mortality in SBP. Administering albumin in SBP has shown significant absolute risk reductions in renal failure and mortality.
• AASLD guidelines recommends 1.5 g albumin per kg body weight within 6 hours of detection of SBP and 1.0 g/kg on day 3 (Class IIa, Level B).
• Do all patients with SBP need albumin? There is some evidence that administrating albumin particularly benefits SBP patients who also have a total bilirubin >4 mg/dL, BUN >30mg/dl or a serum creatinine >1mg/dl.
• 5% albumin is 12.5 grams of albumin diluted into 250cc bag, whereas 25% albumin is 12.5 grams is mixed into 50cc. It is thought that 1 unit of albumin (12.5g) is four times as effective in expanding plasma volume compared to crystalloid but that data for that is not well cited.

References

• 1:46 Runyon, Bruce “Management of adult patients with ascites due to cirrhosis: update 2012” AASLD Practice Guidelines 2012. https://www.aasld.org/sites/default/files/guideline_documents/adultascitesenhanced.pdf
• 1:50 Trends in pneumonia mortality rates and hospitalization by organism, United States, 2002-2011 https://wwwnc.cdc.gov/eid/article/22/9/15-0680-f2
• 2:30 Felisart J, Rimola A, Arroyo V, Perez-Ayuso RM, Quintero E, Gines P, Rodes J. “Cefotaxime is more effective than is ampicillin-tobramycin in cirrhotics with severe infections.“Hepatology. 1985 May-Jun;5(3):457-62.
• 2:47 Rimola A, et al. “Two different doses of cefotaxime in the treatment of spontaneous bacterial peritonitis in cirrhosis: results of a prospective randomized, multicenter study.”Hepatology. 1995 Mar;21(3):674-9.
• Runyon BA, McHutchison JG, Antillon MR, Akriviadis EA, Montano AA. “Short-course versus long-course antibiotic treatment of spontaneous bacterial peritonitis.”Gastroenterology. 1991 Jun;100(6):1737-42.
• 4:00 The SAFE study Investigators “A comparison of albumin and saline for fluid resuscitation in the intensive care unit.” N Engl J Med 2004; 350:2247-2256
• Roberts I, Blackhall K, Alderson P, Bunn F, Schierhout “Human albumin solution in resuscitation and volume expansion in critically ill patients.” Cochrane library. November 2011.
• 4:15 Sort et al. “Effect of Intravenous albumin of renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis.” N Engl J Med 1999; 341:403-409
• 7:08 Mendez CM, McClain CJ, Marsano LS “Albumin therapy in clinical practice” Nutrition in Clinical Practice 2005 20:314
• Horsey PJ “The Cochrane 1998 Albumin Review – not all it was cracked up to be.” European Journal of Anaesthesiology October 2002;19:701-704.
• 9:00 Sigal SH, Stanca CM, Vernandez J, Arroyo V, Navasa M “Restricted use of albumin for spontaneous bacterial peritonitis.”Gut. 2007 Apr;56(4):597-9.