At what drained volume does albumin become necessary?

Below about 5 litres, crystalloid or no replacement is usually adequate. Once more than 5 litres is removed, albumin at 6 to 8 g per litre of ascites markedly reduces the incidence of post-paracentesis circulatory dysfunction, which otherwise shows up as a rise in renin and aldosterone, hyponatraemia, and renal impairment.

Is 20 percent albumin or 5 percent albumin preferred?

Either can be used as long as the total gram dose matches. Concentrated 20 percent albumin is often chosen because it delivers the same dose in a much smaller volume, which matters in patients who are already fluid-overloaded, and it is frequently cheaper per gram.

Do synthetic colloids work as well?

Dextran 70 is intermediate, clearly better than no replacement but inferior to albumin. Gelatins and hydroxyethyl starches are inferior and starches carry additional renal risk. For this indication albumin remains the reference standard.

Albumin Dose After Large-Volume Paracentesis

Work out the grams of albumin to give after draining ascites, using the 6 to 8 g per litre rule for taps over 5 litres. The aim is to blunt post-paracentesis circulatory dysfunction and the drop in effective circulating volume.

Enter the volume of ascites removed. Albumin 6–8 g per litre is recommended when more than 5 L is removed (AASLD / EASL).

Ascites removed (litres)

Volume removed exceeds the 5 L threshold — albumin replacement is indicated.

48g albumin

Recommended dose at 8 g/L (range 36–48 g). Equivalent to 240 mL of 20% albumin or 192 mL of 25% albumin.

Measure	Value
Albumin at 6 g/L	36 g
Albumin at 8 g/L (recommended)	48 g
20% albumin volume	240 mL
25% albumin volume	192 mL

Clinical Guidance

Large-volume paracentesis (removing more than 5 L of ascites) can cause post-paracentesis circulatory dysfunction, characterised by renin–angiotensin activation, hyponatraemia, and renal impairment. Albumin infusion at 6–8 g per litre of ascites removed prevents this, with 8 g/L the most commonly used dose. The AASLD and EASL guidance recommend albumin when more than 5 L is removed.

For volumes of 5 L or less, albumin is generally not required unless the patient has other risk factors. 20% and 25% albumin preparations are concentrated, so the equivalent volume is small — confirm the concentration on the product label before administration.

How It Works

Each component has a specific meaning:

6 — The 6 recorded for the scenario being assessed.

Note: Interpret the albumin after paracentesis result against the thresholds and context described above.

How to Use

Enter the 6 for the scenario you are assessing. Work out the grams of albumin to give after draining ascites, using the 6 to 8 g per litre rule for taps over 5 litres. The aim is to blunt post-paracentesis circulatory dysfunction and the drop in effective circulating volume. Use the albumin after paracentesis result to inform your calculation.

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