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

Time Stamps

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

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