1. BY
MS BINCY JOHN,Dr Deepak Agarwal

2.  HYPOPROTEINEMIA OCCURS COMMONLY IN THE
SEVERE HEAD INJURY PATIENTS DUE TO
DECREASED SYNTHENSIS BY THE LIVER OR
INCREASED LOSSES EITHER INTERNALLY OR
EXTERNALLY.ADMINISTRATION OF ALBUMIN
SOLUTIONS TO CORRECT HYPOPROTEINEMIA IN
SEVERE HEAD INJURY PATIENTS IS VERY
COMMON

3.  HOWEVER ITS USE IS DEBATEABLE. MOREOVER
ALBUMIN, ADMINISTRATION MAY ALSO HAVE
DELETERIOUS EFFECTS INCLUDING ALTERED
COAGULATION,ALTERED RENAL
FUNCTION,DECREASED MYOCARDIAL
CONTRACTILITY,IMMUNOSUPPRESSION AND
WORSENED EDEMA.

4.  IT IS A PROSPECTIVE STUDY WHICH WAS
CONDUCTED IN A NEUROSURGERY WARD OF
TRAUMA CENTRE, IN SEVERE HEAD INJURY
PATIENTS FROM THE MONTH OF JANUARY 2013.
 THE DATA WAS COLLECTED THROUGH THE
RECORDS AVAILABLE IN THE NEUROSURGERY
WARD AND ALSO THROUGH ELECTRONIC
HEALTH RECORD OF EACH PATIENT
MAINTAINED

5.  A TOTAL OF 13 PATIENTS WITH SEVERE
HEAD INJURY ( I.E HISTORY OF
TRAUMA,EVIDENCE OF HEAD TRAUMA IN
CT SCAN AND A SCORE OF 3-8 ON THE
GLASGOW COMA SCALE) WERE INCLUDED
IN THE STUDY.

6.  TOTAL OF 13 PATIENTS RECEIVED ALBUMIN
FROM THE MONTH OF JANUARY 2013. OUT
OF THIS TOTAL NUMBER 92% WERE MALES
AND 8% WERE FEMALES.
SCALE FOR AGE GROUP
AGE GROUP DENOTES
10 TO 30 1
31 TO 50 2
51 TO 70 3
71 AND ABOVE 4

7. AGE FREQUENCY PERCENT CUM
1 3 23.08 23.03
2 8 61.54 84.62
3 1 7.69 92.31
4 1 7.69 100
TOTAL 13 100

8.  AGE IN CORRESPONDENCE TO SURVIVAL
/DEATH FREQUENCY TABLE
 SCALE SURVIVAL 00
DEATH 01

9. AGE 00 01 TOTAL
1 1 2 3
33.33 66.67 100
2 4 4 8
50.00 50.00 100.00
3 1 0 1
100.00 0.00 100.00
4 0 1 1
0.00 100.00 100.00
TOTAL 6 7 13
46.15 53.85 100.00

10.  THIS SHOWS THAT A MAJOR GROUP OF PATIENT
WHO RECEIVED ALBUMIN WERE MALES
SPECIFIC TO THE AGE GROUP OF 31 TO 50 YEARS.

11.  PRE AND POST ALBUMIN LEVEL CHART
N 13 13
MEAN 2.12 2.87
SD .53 .87
P50 2.1 3.1
MIN 1.1 1.3
MAX 2.9 4.1
PROB > |Z| = 0.0535

12.  PRIOR TO ALBUMIN ADMINISRATION THE
INITIAL ALBUMIN LEVELS WAS 2.1 .AND POST
ADMINISTRATION THE AVERAGE INCREASE WAS
OF 2.9 WITH THE |Z| = 0.0535 ,MAKING IT
STATISTICALLY INSIGNIFICANT.
 ON A WHOLE ONLY A NET DIFFERENCE OF 0.8
WAS SEEN AMONG THESE PATIENTS

13.  OUTCOME CHART
OUTCOME FREQ PERCENT CUM
00 6 46.15 46.15
01 7 53.85 100
TOTAL 13 100

14.  OUTCOME CHART WITH PRE AND POST
ALBUMIN LEVELS
 SURVIVAL
N 6 6
MEAN 2.4 3.7
SD .39 .60
P50 2.5 3.15
MIN 1.8 2.6
MAX 2.9 4.1
PROB > |Z| = 0.0273

15. DEATH
N 7 7
MEAN 1.8 2.4
SD .52 .89
P50 1.8 2.2
MIN 1.1 1.3
MAX 2.8 4
PROB > |Z| = 0.0178

16.  TOTAL COST CHART ACCORDING TO OUTCOME
OUTC
OME
N MEAN SD P50 MIN MAX
00 6 15000 0 15000 15000 15000
01 7 25000 14142.1
4
15000 15000 45000
TOTA
L
13 20384.
68
11266.0
1
15000 15000 45000
ON AN AVERAGE EACH PATIENT RECEIVED ALBUMIN FOR 4 DAYS ( MIN 3 DAYS
MAX 9 DAYS)MOUNTING TO AN EXPENSE OF RS 20,000 EACH.

17.  NUMBER OF DAYS POST ADMISSION ALBUMIN
STARTED CHART BY OUTCOME
0UTCO
ME
N MEAN SD P50 MIN MAX
00 6 18.33 11.86 13.5 8 37
01 7 18.71 17.71 14 2 51
TOTAL 13 18.53 14.63 14 2 51
POST ADMISSION ON AN AVERAGE OF 19 DAYS ALBUMIN WAS INITIATED IN
THE PATIENTS FOR BOTH SURVIVED AND DEAD PATIENTS

19.  PRIOR
 OBTAIN THE ALBUMIN LEVELS.NORMAL RANGE
3.3 TO 5 G/DL IN ADULTS.
 ENSURE PRE INFUSION OBSERVATIONS.
 ENSURE GOOD VENOUS ACCESS
 PROTECT MEDICINE FROM DIRECT SUNLIGHT
AND PRESERVE AT A TEMPREATURE OF NOT
ABOVE 25 DEGREE C.
 SHOULD NOT BE MIXED WITH OTHER
MEDICINES ,PACKED CELLS OR WHOLE BLOOD.

20.  GENERAL
 CHECK PRODUCT LABEL AND PRESCRIPTION.
CONNECT ALBUMIN ACCORDING TO RELEVANT
INTRAVENOUS THERAPY GUIDELINES USING AN
ASEPSIS
 SET INFUSION RATE ACCORDING TO PRESCRIPTION
BUT ENSURE INFUSION IS COMPLETED WITHIN
THREE HOURS
 THE INTRAVENOUS SOLUTION ADMINISTRATION SET
MAY NEED FLUSHING WITH 0.9% SODIUM CHLORIDE
TO ENSURE THE TOTAL AMOUNT OF ALBUMIN
PRESCRIBED IS INFUSED

21.  RECORD THE FOLLOWING TRANSFUSION
CHART:
 THE BATCH OF THE ALBUMIN
 DATE AND TIME OF STARTING INFUSION
 SIGN THAT YOU ARE RESPONSIBLE FOR ITS
ADMINISTRATION

22.  CHECK PERIPHERAL INFUSION ACCESS SITE
 REDNESS
 SWELLING/INFLAMMATION
 PALLOR
 LEAKAGE/OOZING
 SKIN TEMPERATURE CHANGE
 TENDERNESS
.

23.  OBSERVE FOR MINOR REACTIONS
 MOTTLED APPEARANCE
 DIZZINESS
 RASH
 REDNESS ON CHEST
 FLUSHING
 FEVER
 TACHYCARDIA
 NAUSEA
 CHILLS
 SALIVATION

24.  OBSERVE FOR MAJOR REACTIONS
 RIGOR
 LABOURED BREATHING/WHEEZING
 CHEST PAIN
 BACK OR LOIN PAIN/DARKENED URINE
 LOSS OF CONSCIOUSNESS
 SUDDEN COLLAPSE

25.  VOLUME OVERLOAD CAN OCCUR IF THE DOSAGE
AND RATE OF INFUSION ARE TOO HIGH
.CLINICAL SIGNS AND SYMPTOMS INCLUDE:
 HEADACHE
 DYSPNOEA
 JUGULAR VEIN CONGESTION
 INCREASED BLOOD PRESSURE
 RAISED CENTRAL VENOUS PRESSURE
 PULMONARY OEDEMA
 MEDICAL ASSISTANCE SHOULD BE SOUGHT IF ANY
OF THESE SYMPTOMS OCCUR.

26.  STOP INFUSION.
 INFUSE 0.9% SODIUM CHLORIDE FOR INFUSION
USING NEW INTRAVENOUS SOLUTION
ADMINISTRATION SET
 OBTAIN MEDICAL ASSISTANCE AND RECORD
INCIDENT

27.  USE OF ALBUMIN IN SEVERE HEAD PATIENTS IS
ASSOCIATED WITH INCREASED MORTALITY
RATES HENCE MAKING ITS USE CONTROVERSIAL.
 ALBUMIN ADMINISTRATION IN THE CRITICALLY
ILL HAS BEEN DEBATED INTENSIVELY
 ALBUMIN IS STOPPED AT MANY ICUS EVEN
THOUGH A NEW STUDIES COULD NOT CONFIRM
ANY ADVERSE EFFECT OF ALBUMIN ON
MORTALITY.