白蛋白（人源與犬源）
**白蛋白**是一種天然蛋白質膠體，主要用於重症監護環境中，以治療嚴重的低白蛋白血症和低血容。它在維持血管內膠體滲透壓方面扮演著關鍵角色。 * **人血清白蛋白 (HSA)：** 由於容易取得，常在獸醫學中使用，但將其作為「異種白蛋白」用於犬貓會帶來嚴重的、甚至致命的免疫介導過敏反應風險。 * **犬專用白蛋白：** 市面上有凍乾粉產品，能顯著降低物種特異性過敏反應的風險，但與人源白蛋白相比，其臨床數據仍然有限。 > **臨床要點：** 強烈不建議在健康的犬隻身上使用人源白蛋白（例如僅用於擴充血容），因為與免疫力低下的重症病患相比，健康犬隻發生嚴重遲發性過敏反應（第三型/血清病）的機率更高。
作用機制: 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.
各物種劑量
- 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%).
劑量為合格獸醫專業人員的臨床參考。請務必對照最新藥品仿單及個別病患確認。
給藥途徑
禁忌症
- 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)
不良反應
- 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
藥物相互作用
- 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.
監測
- 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
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.
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