In a follow-up to my own earlier question about a patient with extravascular expansion secondary to congestive heart failure (CHF) and simultaneous intravascular depletion (Item 100-14), is there any indication for albumin in CHF or edema of any other cause?
—Ed Soumi, MD, Las Vegas

Aside from the rare situation in which the serum albumin is very low (<1.8 g/dL)—due to concomitant cirrhosis, severe malnutrition, or chronic cachexia, for example—I stand by my earlier statement that there are few indications for albumin use in patients such as the one described. Unfortunately, even with low serum albumin levels, administration of albumin may have only transient beneficial effects (N Engl J Med. 2004;350:2247-2256).
—Peter F. Cohn, MD (101-25)