Rapid replacement of serum albumin in patients receiving total parenteral nutrition.

The albumin deficit (AD) of 13 malnourished patients with serum albumin concentrations (SAC) of less than 3.0 grams per deciliter was estimated using a simple equation. The AD was replaced over a period of 24 to 72 hours as a component of the formulation of total parenteral nutrition (TPN). AD was estimated assuming a volume of distribution of 3 deciliters per kilogram of actual body weight and a minimum acceptable SAC of 3.5 grams per deciliter. The mean AD was 200 +/- 94 grams (mean +/- standard deviation), the average dose administered was 206 +/- 97 grams. TPN regimens provided 42.0 +/- 8.5 nonprotein kilocalories per kilogram with a nonprotein calorie to nitrogen ratio of 125 to 150:1. The SAC increased from 2.36 +/- 0.38 grams per deciliter to 3.46 +/- 0.26 grams per deciliter immediately after replacement. At follow-up study, the SAC at 6.4 +/- 1.5 days yielded a SAC value of 3.35 +/- 0.30 grams per deciliter, indicating no significant decrease from immediate replacement values. AD can be easily estimated, rapidly replaced and maintained with adequate nutritional support.