Compare and contrast albumin and gelatins (Haemaccel and Gelofusin) as volume replacement fluids in the critically ill patient.
|
Albumin |
Haemaccel & |
|
|
Pharmacology |
5% and 20%, |
Semisynthetic, |
|
Shelf life |
1 yr shelf life at |
Long shelf lives |
|
Indications for use |
Used for treatment |
Used for |
|
Published data |
Proven to be Tendency for better |
No published data |
|
Side effects |
No risk of |
Lower risk of |
|
Complications |
Risk of CJ disease |
No risk or lesser |
Physiological responses to concentrated human albumin and to Gelofusine are discussed in greater detail elsewhere. Haemaccel is not used locally, and thus I have never had very much interest in it (sorry, Haemaccel enthusiasts).
This question asks the candidate to compare and contrast them as volume replacement fluids in the critically ill patients. Sukanaya Mitra published a 2009 paper which goes some of the way towards answering this question for us; it summarises the key concepts, and expands on the range of colloids by also discussing the hydroxyethyl starches and dextrans.
Out of respect for this paper, I will make an attempt to summarise it into a table format.
| Property | Albumin (20%) | Gelofusine 4% | Dextran (10%) | Hydroxyethyl starch 6% |
| Drug class | Endogenous protein | Succynylated bovine gelatin | Branched polysaccharide | Amylopectin derivative |
| Molecular weight | 69 000 Da | 5 000 - 15 000 Da | 14 000-18 000 Da | 70 000 Da |
| Plasma halflife | 24 hours | 2.5 hours | 12 hours | 5 days |
| Elimination | Degradation by reticuloendothelial system | Renally excreted | Renally excreted | Some renally excreted, some metabolised by the reticuloendothelial system |
| Plasma expansion as a percentage of infused volume | 200-400% | 70-80% | 100-150% | ~100% |
| Advantages |
Antioxidant effects Free radical scavenging effects Protection of glycocalyx |
Cheap Relatively safe in renal failure No limits on infused volume |
Decreases the viscosity of blood, improving microcirculation No risk of CJ disease |
Cheap Large maximum allowable volume No risk of CJ disease Lowest risk of anaphylactoid recations among non-albumin colloids |
| Disadvantages |
Volume overload Transfusion reaction Expensive Risk of CJ disease |
Volume overload Anaphylactoid reactions Coagulopathy |
Volume overload Anaphylaxis Coagulopathy Interference with ABO crossmatch Renal failure (ATN) |
Volume overload Anaphylactoid reactions Coagulopathy Accumulation Renal failure Increase in amylase |
Evidence:
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The albumin page and Gelofusine page are extensively referenced and I will not reproduce that stuff here.
Mitra, Sukanya, and Purva Khandelwal. "Are all colloids same? How to select the right colloid?." Indian journal of anaesthesia 53.5 (2009): 592.
Finfer, Simon, et al. "A comparison of albumin and saline for fluid resuscitation in the intensive care unit." N Engl j Med 350.22 (2004): 2247-2256.
Ertmer, Christian, et al. "Relevance of non-albumin colloids in intensive care medicine." Best Practice & Research Clinical Anaesthesiology 23.2 (2009): 193-212.
Myburgh, John A., et al. "Hydroxyethyl starch or saline for fluid resuscitation in intensive care." New England Journal of Medicine 367.20 (2012): 1901-1911.