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Assessment of Laboratory Values

Albumin and Malnutrition

Reference Level at some Facilities (Check yours)
Albumin: 3.7 to 4.7 g/dL

4 g/dL 2.5 – 4.8 – 3.7 g/dL < 2.Albumin: Nutritional Assessment Normal Mild depletion Moderate depletion Severe depletion 3.7 g/dL 2.1 – 2.1 g/dL .

 Albumin acts like tiny sponges to hold onto water. levels drop with edema and increase with dehydration .Albumin: Facts  Major plasma protein  Normal A/G (albumin to globulin) ratio is 1½ to 2  Major determinant of intravascular volume and responsible for 70% of colloidal osmotic pressure. thus promoting normal oncotic pressure and hydration  Albumin level is strongly influenced by hydration status.

Albumin: Facts  Most nutrition texts state that Albumin levels ranging from 3.0 g/dL reflect normal protein status.  Albumin level suggests protein status over the past 12-21 days. .5 to 5.  Not an acute sensor of nutritional status in critically ill individuals or of early malnutrition.

– bilirubin. – metals . – hormones. – Rx.Albumin: Facts  Albumin is the major carrier for non-soluble substances such as: – lipids.

(inadequate intake of calories and protein)  Kwashiorkor: Hyoalbuminemic Malnutrition (inadequate intake of protein. energy intake may be marginal) .Marasmus Vs Kwashiorkor  Marasmus: Starvation or Fasting Weight is often </= 80% of normal but albumin may be within the reference range.

Starvation and Glycogen Stores Total caloric value of liver and muscle glycogen and circulating free glucose is approximately 1200 kcal. less than 1 day’s resting energy requirement .

impaired wound healing. impaired organ function and death .Starvation and Body Protein Stores  Body protein content is approximately 12 kg. enough to theoretically supply 2 weeks worth of energy needs  Total depletion of protein would have profound adverse effects. including depletion of visceral proteins. decreased immune response.

the body’s fat supply is the major determinant of the length of survival.Starvation and Fat Stores  During prolonged fasting. which in a nonobese individual coincides roughly with the predicted time of depletion of fat stores (approximately 60 to 75 days) .

Protein Status in Marasmus (fasting malnutrition)  During starvation: – Glycogen stores are depleted within 24 hrs – Insulin levels drop – About 75 grams of muscle protein (12 g nitrogen) are catabolized during the first 2-3 days of a fast (for gluconeogenesis) – Voluntary reduction in physical work usually occurs (to reduce energy expenditure) – Involuntary reduction in BMR (to reduce the rate of deterioration of body stores) .

Thermodynamic Law of Starvation  When the initial changes (reduction of BMR.) do not reequate energy status. etc. . the body switches to a fat burning engine to preserve protein stores.

Body Proteins  Somatic Proteins = Muscle Proteins  Gut Proteins  Visceral Proteins = Organ Proteins .

.Changes in Body Proteins with Marasmus  Decrease in somatic and gut proteins  Conservation of visceral protein stores  Weight is often </= 80% of normal but Albumin may be within the reference range.

Albumin in Kwashiorkor  Kwashiorkor: protein depletion or hypoalbuminemic malnutrition  Weight may be normal or excessive. but protein stores (albumin) is low  Conservation of somatic proteins .

Protein Wasting and Cancer Cachexia  Cancer Cachexia represents a maladaptation to the fasting state with ongoing mobilization of proteins  Decrease in protein synthesis also occurs .

Albumin is Decreased in:  Protein/calorie malnutrition (inadequate calorie & protein intake results in eventual depletion of protein stores)  Kwashiorkor (= hypoalbuminemia)  Liver disease (liver synthesizes albumin)  Metabolic Stress (decreased albumin seen w/ inflammation & infections. synthetic functions switch to provide acute phases proteins)  Catabolism (breakdown of muscle mass) .

. and edema.g. nephrotic syndrome is associated with urinary loss of albumin and is characterized by hypoalbuminemia. Protein restriction rather than supplementation is more effective at managing this disorder. hyperlipidemia.Albumin is Decreased in  Malabsorption  Edema/ascites (increased fluids dilute albumin level)  Cancer Cachexia (associated w/ wasting of LBM)  Renal Disease (e.

and acute catabolic states.Lab Tests used to Asses Protein / Nutritional Status  Albumin (1/2 life of 12-21 days)  Retinol Binding Protein (1/2 life of 10-12 hours): circulates in a 1:1 molar ratio with PAB and transports vitamin A W/ renal disease. its half-life is prolonged.  Prealbumin (1/2 life of 2-3 days)  Transferrin (1/2 life of 8-10 days)  Cholesterol . Levels decrease in hyperthyroidism. vitamin A deficiency.

0 g/dL Low Very low Low Low Declining or < 160 mg/dL (when not on Rx) Very low Low Cholesterol < 200 mg/dL Unchanged Unchanged .5-5.Lab Test / ½ life (CASE program) Retinol Binding Protein / 8-10 hrs Prealbumin / 2-3 days Albumin / 12-21 days Normal Value 2.6-7.6 mg/dL PCM AIR Infection Low Unchanged Unchanged 16-36 mg/dL 3.

hemodialysis (attributed to decreased renal catabolism of PAB) Overhydration. liver disease. metastatic carcinoma.7 gdL (but normal protein status reflected by 3. malnutrition.4 increases risk of edema) none Dehydration and diabetes insipidus (increased thirst.7-4.7) 17-39 mg/dL Critical Values States associated with Hyper levels States associated with Hypo levels Albumin None (but albumin <2.5-4. dialysis Malnutrition. mainly intracellular). nephrotic syndrome. stress. burns. urination and fatigue without change in blood glucose) Euvolemic status in chronic renal failure (excess body water. infection Prealbumin Transferrin 204-345 mg/dL none Increased iron stores Iron deficiency. malabsorption.Laboratory Assessment Lab Test Reference Ranges at some Facilities 3. blood loss. liver disease . liver failure.

Protein Depletion Albumin (g/dL) 3.7 2.7 <2.1-2.4 2.8-3.5-4.1 Prealbumin Transferrin (mg/dL) (mg/dL) 17-39 201-345 10-16 7-10 <7 151-200 100-150 <100 “Normal” Mild Depletion Moderate Depletion Severe Depletion .