Should adding albumin to parenteral nutrient solutions be considered an unsafe practice?

Abstract

The technical issues surrounding the use of albumin in parenteral nutrient (PN) solutions are reviewed. Five criteria have been suggested to determine which compounds are optimal for addition to PN solutions: (1) stable dosage regimen over 24 hours, (2) pharmacokinetic profile supporting a 24-hour infusion, (3) stable PN solution infusion rate, (4) documented physical stability over at least 24 hours, and (5) documented chemical stability over at least 24 hours. Albumin is stable in solutions containing dextrose and electrolytes, but its stability in solutions containing dextrose and amino acids has not been evaluated. Signs of precipitation and flocculation have been reported when albumin and zinc chloride were added simultaneously to a two-in-one PN solution. Similar to hemoglobin, albumin is nonenzymatically glycosylated in vivo. One of the most common complications associated with the use of PN solutions is catheter-related bloodstream infection. Albumin 25 g/L in two-in-one PN solutions has been shown to clog 0.2-microm filters. Albumin products have historically contained a large amount of aluminum contamination; thus, the addition of albumin to PN solutions would further contribute to accumulated aluminum contaminants in patients receiving PN therapy, particularly neonates. Based on the available evidence, the addition of albumin to PN solutions cannot be recommended. The potential for complications due to infection and physical and chemical incompatibility and instability exists. Adding albumin to PN solutions can affect infusion flow rates and pump pressures, thereby compromising the appropriate delivery of PN solutions to patients. The theoretical risk of glycosylation and related complications outweigh potential benefits of albumin administration via PN solution.