• In the study, 161 patients (91%) administered HSA had serum albumin values of <3.5 g/dL, while in only 36% of patients were these values <2.5 g/dL.• The most common daily dosage was 10 g of HSA, corresponding to 50 mL of 20% HSA.• In the majority of cases, HSA was erroneously prescribed, often to enhance diuretic efficacy or in protein energy malnutrition.• The new Italian Ministry of Health recommendations did not influence how albumin was prescribed. Here, ALB is linked to protein-energy malnutrition.