アルブミン（人由来および犬由来）
**アルブミン**は、主に重症集中治療において重度の低アルブミン血症および循環血液量減少の管理に使用される天然タンパク質コロイドです。血管内膠質浸透圧の維持に重要な役割を果たします。 * **ヒト血清アルブミン (HSA):** 入手が容易なため獣医療で頻繁に使用されますが、犬や猫に「異種アルブミン」として使用すると、重篤で致命的な免疫介在性過敏反応のリスクを伴います。 * **犬用アルブミン:** 凍結乾燥製品として市販されており、種特異的な過敏反応のリスクを大幅に軽減しますが、HSAと比較して臨床データはまだ限られています。 > **臨床のポイント:** 健康な犬へのヒトアルブミンの使用（単純な循環血液量増加目的など）は強く推奨されません。免疫抑制状態にある重症患者と比較して、重篤な遅発性過敏反応（III型/血清病）の発生率が高いためです。
作用機序: Albumin is the primary plasma protein responsible for maintaining intravascular volume. * **Oncotic Pressure:** Provides 75-80% of the oncotic pressure of plasma → reduces hydrostatic pressure → prevents crystalloid fluids from leaking into the interstitium → decreases edema and improves organ perfusion. * **Transport & Binding:** Acts as a carrier protein, binding and transporting drugs, ions, hormones, lipids, and metals (like iron). * **Endothelial & Systemic Effects:** Maintains endothelial integrity, exerts **antioxidant** properties (via thiol groups), aids in acid-base balance, decreases platelet aggregation, and augments antithrombin activity.
動物種別の用量
- Refractory hypotension or severe hypoalbuminemia (using 25% Human Albumin) · Test dose of 0.25 mL/kg/h is given over 15 minutes. The maximum volume administered to any dog by the author is 25 mL/kg (6.25 g/kg) administered continuously over 72 hours; the mean volume administered to any dog overall is 5 mL/kg (1.25 g/kg). The maximum volume given as a slow push or bolus to treat hypotension is 4 mL/kg (1 gram/kg), with a mean volume of 2 mL/kg (0.5 g/kg). The range for a continuous rate infusion (CRI) after a bolus administration is 0.1 to 1.7 mL/kg/h (0.025-0.425 g/kg) over 4 to 72 hours. · IV · CRI or bolus · 4 to 72 hours · Discontinue infusion if adverse signs develop. Infusions are empirically selected to meet low normal values.
- Marked hypoalbuminemia (using 10% Human Albumin) · albumin deficit (g) = 10 X (serum albumin desired - serum albumin of patient) X body weight (kg) X 0.3. Alternatively, some dogs received 0.5 to 1.25 g/kg. · IV · over a 12-hour period · 12 hours · Dilute 25% human albumin to a 10% solution with 0.9% NaCl. Administer with a transfusion filter. No dog is eligible for additional human albumin after 7 days following initial administration.
- Hypovolemic shock or hypoalbuminemia (using Canine Albumin 5g lyophilized) · A total of 2.5-5 mL/kg body weight is recommended. Administer IV at a dosage rate of 1 mL/min. · IV · Single dose · Until calculated volume is administered · Dilute to 16% (add 30 mL of diluent such as sterile normal saline, Normosol or dextrose 5%).
用量は獣医療従事者向けの臨床リファレンスです。必ず最新の添付文書と個々の患者で確認してください。
投与経路
禁忌
- History of hypersensitivity to albumin (human or canine)
- Repeat administration of xeno-albumin (human albumin in dogs) beyond 7 days
- Healthy animals with simple volume depletion (avoid xeno-albumin)
- Pre-existing conditions resulting in volume overload
- Severe anemia or extreme dehydration (unless concurrent RBCs or appropriate crystalloid fluids are administered first)
有害事象
- Immediate hypersensitivity (anaphylaxis, facial edema, vomiting, urticaria, hyperthermia, shock)
- Delayed hypersensitivity / Type III serum sickness (lethargy, lameness, peripheral edema, cutaneous lesions/vasculitis, renal failure, coagulopathies)
- Volume overload
- Diarrhea
- Tremors
- Perivascular inflammation at catheter sites
薬物相互作用
- Highly protein-bound drugs · Exogenous albumin may bind to these drugs, potentially affecting the amount of free (active) drug circulating, though this rarely appears to be clinically significant.
モニタリング
- Pre- and post-infusion serum albumin (target 2.0-2.5 g/dL)
- Pre- and post-infusion colloid osmotic pressure (COP)
- Vital signs: body temperature, respiratory rate, blood pressure, and heart rate
- Signs of volume overload (e.g., increased respiratory effort, chemosis)
- Immediate hypersensitivity (facial edema, vomiting, urticaria)
- Delayed hypersensitivity reactions (can occur weeks after administration)
過量投与
Overdosage can lead to **hyperalbuminemia** and **hyperproteinemia**, resulting in severe volume overload and hyperviscosity. To avoid these effects, serum albumin levels should be closely monitored. Most experts recommend that serum albumin should not exceed **2.5 g/dL** (some suggest a strict maximum of 2.0 g/dL) when used clinically.
VetSheet の薬剤リファレンスは、獣医療従事者向けの臨床意思決定支援を目的としており、専門的判断やメーカーの最新添付文書に代わるものではありません。