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

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

Disposition

See Also

External Links

References

Authors:

Claire