Evaluation of serum albumin utilization in inpatient at a private hospital in Bangkok.

Serum albumin is widely used for the treatment of hypovolemia, shock, hyperbilirubinemia or acute liver failure. However, serum albumin itself may have a significant effect on the action, elimination or distribution of other medications in blood which may affect the outcome of the treatment. Besides, it is also expensive and, most important, can be a carrier for many life-threatening diseases such as AIDS. The objective of this study is to evaluate the serum albumin utilization in inpatient at a private hospital in Bangkok, Thailand. Descriptive, retrospective study was designed to monitor the 25% w/v serum albumin orders over a four-month period. The background information, doses and rational of serum albumin orders, other medication orders, side effects, the interaction between serum albumin and other medications, the laboratory results and also clinical outcome of the patients were recorded. From the medication orders of 74 inpatients, there were 104 orders of serum albumin for 9 indications. The most common indications were hypoalbuminemia (48%) and cirrhosis (9%). From the total number of serum albumin orders, there were only 67 orders (64.4%) prescribed with rational dose and duration under appropriate indications. Totally about 35.6% of serum albumin orders were prescribed with improper indications such as edema, anemia or coronary artery bypass grafting. Out of 35.6%, 14% of the orders were prescribed to contraindicated patients. No side effect of serum albumin infusion was found during this study. The result indicates the over-utilization of serum albumin and specific guideline for using this agent should be set in every hospital.