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Standardized order set during LVP safely lowers amount of albumin dosing

29 Sep 2020

Using an order set to guide albumin dosing based on the amount of ascitic fluid removed during large volume paracentesis (LVP) substantially reduces the quantity of albumin given with no difference in adverse effects, results of a study have shown.

The investigators examined the impact of implementing a standardized LVP order set on albumin utilization and patient outcomes in this retrospective review of patients with ascites due to cirrhosis who received a therapeutic paracentesis at a large, academic institution. Albumin doses were standardized in the order set to 25 g (5-6 L removed), 50 g (7-10 L), and 75 g (>10 L).

The amount of albumin used prior to and after order set implementation was the primary outcome. Other patient outcomes included rates of hyponatraemia, renal impairment, and hypotension.

Each arm included 100 patients in the final analysis. Patients prior to order set implementation received a higher amount of albumin per litre removed than those postimplementation (8.3 vs 6.5 g/L; p<0.01).

No significant between-group differences were seen in absolute changes in serum sodium (0 vs −1 mEq/L; p=0.64), serum creatinine (0.06 vs 0.05 mg/dL; p=0.94), or systolic blood pressure (−4 vs −3 mm Hg; p=0.96). No differences were also noted in rates of hyponatraemia (1.6 percent vs 6.6 percent; p=0.21), renal impairment (11.3 percent vs 11.5 percent; p=0.97), or hypotension (17.4 percent vs 17.6 percent; p=0.97) between the two groups.

“Albumin after LVP reduces paracentesis-induced circulatory dysfunction. The most efficacious dose of albumin for LVP is unclear,” the investigators said.

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Most Read Articles
Roshini Claire Anthony, 09 Oct 2020

The risk of falls and subsequent injuries (eg, fractures) may be elevated in individuals with diabetes compared with the general population, according to a nationwide cohort study from Denmark.

Audrey Abella, 10 Sep 2020
Interim results of REGENERATE* trial highlight the ability of experimental noninvasive tests to evaluate treatment response in adults with NASH** and advanced liver fibrosis who are receiving obeticholic acid (OCA).
Rachel Soon, 28 Aug 2020
MOH Director-General Tan Sri Dato' Seri Dr Noor Hisham Abdullah speaks about NHMS 2019 and pharmacists' roles in combating NCDs among Malaysians.
Jairia Dela Cruz, 23 Sep 2020
The combination of pitavastatin and fenofibrate appears to have superior effect on non-high-density lipoprotein cholesterol (non–HDL-C), as well as other lipids, compared with a statin alone in high-risk patients with mixed dyslipidemia, according to a study.