Albumin infusion may deleteriously promote extracellular fluid overload without improving circulating hypovolemia in patients of advanced cirrhosis with diabetes mellitus and sepsis.

In patients with liver cirrhosis, albumin is given to improve relative hypovolemia caused by marked splanchnic arteriolar vasodilatation. However, the volume effect of albumin is not predictable and depends also on capillary permeability, hydrostatic pressure and lymphatic ability to re-circulate albumin from interstitium to plasma. In patients with decompensated cirrhosis, the capillary permeability is increased, hydrostatic pressure is higher, and the lymphatics functions are deficient. Hence the albumin molecules are more likely to be extravasated rapidly into the interstitium and are subsequently less likely to be re-circulated back into the plasma. This would not only fail to correct circulating hypovolemia, the purpose for which it is given, but also would favor development of reverse colloid oncotic pressure and fluid movement out of the capillaries leading to development of edema. Thus, anything else which could further increase capillary permeability or hydrostatic pressure in cirrhotic patients might create more problems with albumin infusion. An increased capillary permeability is the hallmark of diabetes mellitus. Furthermore, diabetes mellitus may worsen immunodepression in cirrhotic patients thus increasing the incidence of severe infections which may further have a deleterious effect on hemodynamics and capillary permeability. A diabetic patient with advanced cirrhosis and sepsis usually has markedly increased capillary permeability, high hydrostatic pressure due to hyperdynamic circulation, and compromised lymphatic drainage capacity. Hence, using albumin infusion in them would not only fail to improve relative hypovolemia, but also would deleteriously promote extravascular accumulation of fluid, which might impair the functions of many vital organs. However, the efficacy and safety of albumin infusion in diabetic patients with advanced cirrhosis and sepsis is not known. Such data can have a great clinical implication and would necessitate search of a suitable alternative. Because albumin has relatively smaller molecular weight, synthetic colloids with a higher molecular weight might be effective in conditions of increased capillary permeability.