Albumin

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Normal: 3.5 to 5 g/dL

Physiology:

Albumin is synthesized by the liver and is responsible for maintaining plasma oncotic pressure and for binding numerous hormones, anions, and fatty acids.

Hypoalbuminemia: Less than 3.5 g/dL

Causes:

•

Malnutrition, poor protein intake. A low serum albumin develops over weeks of inadequate nutritional intake and will normalize over weeks when adequate nutrients are provided. Thus, the usefulness of serum albumin in nutritional assessment is primarily an indicator of long-term visceral protein status.

•	Impaired digestion due to pancreatic insufficiency and malabsorption. Loss from nephrotic syndrome and burns.

•	Inadequate synthesis due to CHF, cirrhosis, acute stress, hypoxia, burns, some cancers.

Assessment:

Hypoalbuminemia is not associated with specific symptoms or signs until concentrations become quite low. At very low concentrations (2 to 2.5 g/dL), patients can develop peripheral edema, ascites, or pulmonary edema.

Labs:

Mild deficit: 2.8 to 3.5 g/dL

Moderate deficit: 2.1 to 2.7 g/dL

Severe deficit: Less than 2.1 g/dL

TPN correction:

Optimal re-feeding leads to a gradual increase in serum albumin.