American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the appropriate amount of albumin to be given per liter removed during paracentesis if more than 5 L of ascitic fluid is withdrawn?

1. 0.5 g of 25% albumin

2. 1 g of 25% albumin

3. 1.5 g of 25% albumin

4. 2 g of 25% albumin

The correct answer is: 1 g of 25% albumin

The recommended guideline for administering albumin during paracentesis when more than 5 liters of ascitic fluid is removed focuses on preventing potential complications such as post-paracentesis circulatory dysfunction. In such cases, it is advisable to provide 1 g of 25% albumin per liter of fluid removed. This helps to maintain oncotic pressure in the vascular system and prevent complications like hypotension or renal impairment that can arise from significant fluid shifts. Using 1 g of 25% albumin ensures that the body's protein levels are adequately supported after the large-volume removal of fluid. This approach is particularly important in patients with severe ascites and underlying liver disease, as they may have a compromised ability to maintain fluid balance and vascular volume. Therefore, the correct answer aligns with the recommended practice to safeguard patient stability following extensive fluid drainage.