Thanks for your thoughtful reply.
In my view, 25% albumin helps. Why? The effect of 100 cc of 25% albumin given in a vein, IV, it increases serum concentration of albumin. It only adds 100 cc to the body's load. 25% gets rid of edema. It shifts distribution, in a direction desired, reduces interstitial volume and increases plasma volume, which increases renal flow.
As evidence: Lasix alone did not increase urine volume. It did not raise sodium above existing < 5 meq/100 urine. In that particular patient Lasix had no effect. I noted low urine sodium which I took as indirect evidence of low renal blood flow probably due to squeeze and low volume in vessels. I searched for the quickest way to fill vessels, for a substance that stayed in vessels. Packed red cells!. I repeated Lasik after PRBC. PRBC plus Lasix had the desired effect. Urine volume doubled and the kidney began to release sodium. Urine became salty--rising from <5 meq (almost distilled water) to 60 meq/100 cc urine. Renal blood flow had improved after PRBC. The body shed some deadly salt.
As alternatives, to increase blood volume 25% albumin and Hetastarch solutions should help. I repeated trial with them. They both worked to increase Lasix effect. I favor 25% albumin because with added small volume it pulls juice from where juice is not wanted, edema, into where juice (volume) is desired, circulating volume.
Weight gain in patients is deadly. Saline overload is the source. Overload dilutes albumin. 25% albumin seems effective in treating overload. Prevention is better.
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