Hypoalbuminemia
Background
- Albumin is most abundant protein in human
- Synthesized in liver
- Functions include:
- Transport of hormones, fatty acids, and other substances
- Maintenance of oncotic pressure
- pH buffering
- Normal reference range 3.5–5.0 g/dL
- Known as "negative acute phase protein" as levels often drop during times of acute physiologic stress
Clinical Features
- Signs/symptoms of underlying disease (e.g. stigmata of cirrhosis, wasting)
- Third spacing of fluids due to decreased oncotic pressure (e.g. peripheral edema)
Differential Diagnosis
- Liver disease e.g. cirrhosis (most common)
- Excess renal excretion e.g. nephrotic syndrome, glomerulonephritis
- Excess bowel loss e.g. protein-losing enteropathy in Crohn's
- Burns (via plasma loss through the skin)
- Hemodilution e.g. in pregnancy
- Capillary leak e.g. in hantavirus
- Malnutrition
- Genetic mutation (rare)
- Any acute disease state e.g. sepsis, pancreatitis, Kawasaki
Evaluation
- Due to albumin's functions, certain lab values require correction for hypoalbuminemia
- Corrected serum calcium = (0.8 * (Normal Albumin - Pt's Albumin)) + Serum Ca
- Corrected anion gap = anion gap + [ 2.5 × (4 - albumin, g/dL) ]
- Corrected phenytoin level = measured phenytoin level / ( (adjustment x albumin, g/dL) + 0.1)
- Adjustment = 0.275; in patients with creatinine clearance <20 mL/min, adjustment = 0.2.
Management
- Treat underlying disease
- Replacing albumin only indicated in specific disease processes/clinical scenarios
- With large volume paracentesis
- Concern for SBP and creatinine >1mg/dL, BUN >30mg/dL, or T Bili >4mg/dL
- Hepatorenal syndrome
- Consider in acute pancreatitis if albumin <2 g/dL
Disposition
See Also
External Links
References
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