Hypoalbuminemia is defined as serum albumin levels <35 g/L. However, clinical significance is evident for levels <25 g/L. This condition is usually observed in elderly patients, especially among those hospitalized and in states of malnutrition and chronic illness. The associated mechanisms include a decrease in amino acids or energy supply, impaired synthesis in the liver, increased loss (renal or gastro-intestinal), increased tissue catabolism, or distributional issues.

Albumin Supplementation and Fluid Management in Cancer Care: Navigating Complexities

In cancer, hypoalbuminemia shows a biphasic response. Initially, there is a decrease in albumin synthesis due to pro-inflammatory cytokine secretion. This is followed by an overall increase in synthesis. Increased vascular permeability in these patients leads to the redistribution of albumin from the intravascular sector to the interstitium, causing a drop in serum albumin levels. Evidence suggests that low serum albumin levels predict morbidity, mortality, and poor prognosis in both solid and hematological cancers.

Human albumin is prescribed for volume replacement, especially in critically ill patients, with the common indication being hypoalbuminemia with edema. Evidence shows that hypoalbuminemia is present in >75% of critically ill cancer patients. In cancer, the capillary membrane permeability is increased and up to 85% of infused albumin is removed from the vessels into the extravascular space within 2 days of infusion. Poor retention of fluid in the intravascular compartment results in a clinical picture of volume depletion in the presence of edema.

At Sammprada, managing complex scenarios involves ‘volume optimization,’ where we balance replacing intravascular volume while minimizing interstitial fluid accumulation. Due to the unpredictable sensitivity to fluid administration, our treatment regimen integrates both clinical and laboratory assessments to determine when adjustments in fluid therapy are necessary. We take a patient-specific approach to intravenous fluid therapy for cancer patients, with frequent reassessments to ensure desired outcomes are achieved with minimal toxicity.

Reference:

• Moujaess E, Fakhoury M, Assi T et al. The therapeutic use of human albumin in cancer patient management. Critical Reviews in Oncology/Hematology 2017;120:203-209.
• Barlow A, Barlow B, Tang N et al. Intravenous fluid management in critically ill adults: A review. Critical care nurse 2020;40(6):e17-e27.