You just finished a large-volume paracentesis. Eight liters off a patient with tense ascites, they can breathe again, and now you owe them albumin. So you open the order in Epic. That is where it slows down.

You have to remember the dose is about 8 grams per liter removed. You do the multiplication in your head, then remember albumin comes in 25 gram bottles, so you round to something the pharmacy can actually dispense. Then the order opens, and it's a wall of fields: a frequency dropdown with dozens of options, a duration, a rate, a priority, a phase of care, an exception code you've never touched. Most of them you leave alone, but you still have to read each one to know that.

I've watched a lot of residents do this. They hesitate in the same three places every time: the dose, the bottle rounding, and the frequency. None of it is hard. It's just fiddly, and fiddly at the bedside is where mistakes live.

So I built a calculator. You enter the liters removed, and it gives you the dose, rounds it to whole bottles, and fills in every field of the Epic order. Then you copy the whole thing. It's live at albumincalculator.netlify.app.

The problem

The Epic order set for albumin — a dozen fields for a single one-time dose.

Albumin after paracentesis is one of those orders that's simple in concept and annoying in practice. The clinical decision is small: how many grams, given once. But Epic doesn't ask you for grams. It asks for a dose, a route, a frequency, a start time, an administration duration, a rate, admin instructions, a note to pharmacy, a priority, an exception code, a supply, and a phase of care.

For a one-time albumin infusion, almost every one of those has an obvious answer. Frequency is Once. Route is intravenous. But it's only obvious after you've done it fifty times. A resident seeing the order for the first time has to figure out which of the many frequency options means "just give it one time," and whether the rate they typed actually matches the volume and the duration. That part is confusing, and it has nothing to do with medicine.

What I built

The tool runs in three steps, top to bottom. You pick the product and enter the liters removed. It shows you the recommended dose and whether albumin is even indicated. Then it builds the full Epic order underneath, with one button to copy it.

Nothing about it is clever. It just holds all the small decisions in one place so you don't carry them in your head while you're standing at the bedside.

Enter the liters removed; the dose, bottle count, and full Epic order build underneath.

How the dose is calculated

Most guidelines land on 6 to 8 grams of albumin for every liter of ascites removed. The calculator uses 8 grams per liter. That's the top of the range, and it's what the FDA label for 25 percent albumin specifies (8 grams per 1,000 mL removed), which is also what our Epic order set assumes. Picking one number and matching the order set keeps it predictable.

From there it's two steps:

1. Multiply. Liters removed times 8 gives the raw target in grams.
2. Round to a bottle. Albumin is dispensed in 25 gram bottles, so the raw number rounds to the nearest whole 25 grams, and never below one bottle.

Say you removed 8 liters:

• 8 L × 8 g/L = 64 g
• 64 g rounds to 75 g, which is three 25 gram bottles
• 75 g of 25 percent albumin is 300 mL

So the order is 75 grams, given once, and the pharmacy sends up three bottles. The calculator shows the raw number and the rounded number side by side, and tells you whether what you entered comes in under, over, or on target. The rounding is never a black box.

When albumin is actually indicated

This is the part I most wanted guardrails around, because the dose doesn't matter if albumin wasn't indicated in the first place.

• More than 5 liters removed: give albumin. This is the classic large-volume paracentesis threshold.
• 5 liters or less: usually not required. The tool says so instead of just handing you a dose.
• Acute on chronic liver failure (ACLF): give albumin regardless of volume, even for a small tap. There's a checkbox for it, and it overrides the 5 liter rule.
• More than 8 liters in one session: the dose still calculates, but the tool flags it, because the risk of post-paracentesis circulatory dysfunction climbs once you're pulling that much in a single sitting.

So it isn't just a multiplier. It tells you when not to give the drug, which is the more useful thing for someone still learning the indication.

Volume, rate, and duration

Once you have the grams, the order needs a volume and a rate, and those depend on the product.

A 25 gram bottle of 25 percent albumin is 100 mL. A 25 gram bottle of 5 percent albumin is 500 mL. Same grams, five times the volume. For large-volume paracentesis you almost always want the 25 percent, because it delivers the replacement in a fraction of the fluid. The calculator defaults to it for that reason, with 5 percent there if you need it.

Rate, duration, and volume are linked by one equation:

rate = volume ÷ duration

Set any one and the calculator fills in the other. Give that 300 mL a two hour duration and it returns 150 mL/hr. Type a rate instead and it solves for the duration. You're never doing that division yourself.

The Epic order it builds

Everything above feeds a complete order at the bottom of the page: medication, total dose, calculated volume, bottles dispensed, route, frequency, start date and time, duration, rate, admin instructions, note to pharmacy, priority, exception code, supply, and phase of care. Frequency is preset to Once, because albumin after paracentesis is a single replacement dose, not something you schedule.

There's one button: Copy full order. It puts the whole thing on your clipboard as formatted plain text, so you can paste it wherever you need it and check it field by field against Epic. The goal isn't to bypass the order. It's to walk in already knowing every answer.

How it's built

If you came here for the code, this part is almost boring, and that's on purpose.

It's a single HTML file. The markup and the calculator logic live together, plain vanilla JavaScript, no framework. Styling is Tailwind CSS v4 compiled with the Tailwind CLI. It deploys as a static site on Netlify. That's the whole stack.

A few things I did bother to get right:

• It's a progressive web app. There's a service worker and a manifest, so you can add it to your phone's home screen and it works offline. On a floor with bad signal, that matters.
• It has light and dark mode, follows your system theme, and remembers what you picked.
• The inputs use 16 pixel text so iOS Safari doesn't zoom in every time you tap a field. Small thing, deeply annoying when it's wrong.
• The link previews are set up properly, so dropping the URL in a text or a Slack message shows a real card instead of a bare link.

I keep these tools in one file on purpose. If something breaks, I open one file and read it top to bottom. No build server to babysit, nothing to install before I can fix a typo. For a tool I want a busy resident to trust, simple is the feature.

Why it helps

The math isn't the hard part. Anyone can multiply by eight. The friction is everything around the math: the rounding to bottles, the volume that changes with the product, the rate that has to match the duration, and an order set with dozens of frequencies. Spread that across a busy day and it's exactly where someone enters a rate that doesn't match the volume, or doses a 4 liter tap that never needed albumin.

Holding all of it in one place does two things. It makes the common case fast, and it makes the wrong case visible. You still decide. If the patient doesn't fit the rule, the tool tells you, and you use your judgment anyway.

Try it

The calculator is at albumincalculator.netlify.app. It's free, it works on a phone, and it doesn't need a login. If you take care of patients with ascites and you'd rather not do this math at the bedside, use it. If you find an edge case it handles badly, tell me.

---

Dosing logic and sources

• Albumin is recommended when more than 5 L of ascites is removed. For 5 L or less it's generally not required unless the patient has ACLF.
• The dose is 6 to 8 g per liter removed. This tool uses 8 g/L, matching the FDA label for 25 percent albumin (8 g per 1,000 mL) and our Epic order set, rounded to whole 25 g bottles.
• A 25 g bottle of 25 percent albumin is 100 mL; a 25 g bottle of 5 percent is 500 mL. Rate equals volume divided by duration.
• The risk of post-paracentesis circulatory dysfunction rises above 8 L removed in a single session.

References

• Biggins SW, et al. AASLD 2021 Practice Guidance on the management of ascites. Hepatology. 2021.
• Garcia-Tsao G, et al. AGA Clinical Practice Update on the management of ascites. Gastroenterology. 2024.
• Ge PS, Runyon BA. Treatment of patients with cirrhosis. N Engl J Med. 2016.
• FDA. Albuminex (albumin human) prescribing information. 2024.

Clinical disclaimer

This is a clinical decision support tool for licensed clinicians. Check every dose, rate, and duration against your institutional protocol and the patient's clinical context before ordering. It does not replace clinical judgment.