Common Causes
Low albumin or Hypoalbuminemia means abnormally low levels of albumin in the blood. Treatment for low albumin is a low sodium diet is recommended. Research papers have suggested that albumin levels are low in patients consuming high amounts of salt.
Related Conditions
Hypoalbuminemia can affect individuals who were recently hospitalized, especially if they:
- Received fluids from an IV.
- Had surgery.
- Used a ventilator.
- Needed a cardiopulmonary bypass machine (CBM).
How do you treat a low albumin level?
Treatment may include:
- blood pressure medication for people with kidney disease or heart failure
- lifestyle changes, particularly avoiding alcohol in people with liver disease
- medications to manage chronic gastrointestinal disease or reduce inflammation in the body
- medications, such as antibiotics, if a person has hypoalbuminemia after a severe burn
What can cause low albumin?
- Increased vascular permeability (allowing albumin to diffuse into the extravascular space)
- Increased degradation
- Decreased synthesis (among other mechanisms, by activating TNF-a, which decreases transcription of the albumin gene)
How to treat low albumin?
What causes decreased albumin?
See more
How does albumin affect edema?
When albumin levels drop, fluid may collect in the ankles (pedal edema), lungs (pulmonary edema), or abdomen (ascites). Many things can cause low albumin levels.
What happens when albumin is decreased?
Without enough albumin, your body can't keep fluid from leaking out of your blood vessels. Not having enough albumin can also make it harder to move important substances throughout your body. Some of these substances are used for essential processes to keep your body fluids in check.
Does albumin cause fluid retention?
Human serum albumin accounts for some 60% of the intravascular protein pool in healthy individuals, thereby being responsible for approximately 60% of plasma colloid oncotic pressure. Albumin is also responsible for water retention as the negative charges surrounding the protein molecules attract sodium ions.
How does low blood albumin affect fluid distribution in the body?
Thus, hypoalbuminemia leads to abnormal distributions of fluids within the body and its compartments. As a result, associated symptoms include edema in the lower legs, ascites in the abdomen, and effusions around internal organs. Laboratory tests aimed at assessing liver function diagnose hypoalbuminemia.
How does albumin maintain osmotic pressure?
Intravascular concentrations of albumin are maintained during times of loss by the movement of interstitial albumin into the lymphatic circulation and then the cranial vena cava, as a means to maintain the pressure gradient between the intravascular and interstitial spaces.
What are 3 functions of albumin?
Albumin is a simple protein present both in animal and plant physiological fluids and tissues. It plays many important roles including maintenance of appropriate osmotic pressure, binding and transport of various substances like hormones, drugs etc. in blood, and neutralisation of free radicals.
Can low albumin cause leg swelling?
The proteins help to hold salt and water inside the blood vessels so fluid does not leak out into the tissues. If a blood protein, called albumin, gets too low, fluid is retained and edema occurs, especially in the feet, ankles and lower legs.
Does albumin help with edema?
As mentioned above, albumin has been used to improve edema in patients with nephrotic syndrome in addition to diuretics [1]. However, the improvement in edema was not observed in all patients.
How does Hypoproteinemia cause edema?
Decreased serum protein reduces the oncotic pressure of the blood, leading to loss of fluid from the intravascular compartment, or the blood vessels, to the interstitial tissues, resulting in edema. This is termed as hypoproteinemia.
Can low protein cause water retention?
Because of reduced human serum albumin levels, severe protein deficiency leads to lower oncotic pressure. As a result, fluid accumulates in tissues, causing swelling. For the same reason, protein deficiency may lead to fluid buildup inside the abdominal cavity.
Why does albumin help with blood pressure?
In addition, albumin acts as an important extracellular antioxidant. Conceivably, a positive correlation has been observed between the serum albumin concentration and blood pressure [10,11], since this protein has an important role in keeping the colloid osmotic pressure in blood.
Why is albumin important in the body?
Albumin helps move many small molecules through the blood, including bilirubin , calcium, progesterone, and medicines. It plays an important role in keeping the fluid in the blood from leaking into the tissues.
Is low albumin life threatening?
Depending on what caused your levels of albumin to decrease, treatment of the underlying condition can alleviate symptoms of hypoalbuminemia and increase your albumin proteins to a normal level. If left untreated, hypoalbuminemia can be life-threatening.
What happens if albumin is high?
High albumin levels are typically the result of dehydration or severe dehydration. The test is very quick and doesn't carry any serious risks. Last reviewed by a Cleveland Clinic medical professional on 02/02/2022.
What is low albumin called?
Hypoalbuminemia occurs when albumin levels in the blood are very low. Albumin is a blood protein that makes up a significant portion of the blood plasma.
What does low albumin in elderly mean?
Albumin is a good marker of nutritional status in clinically stable people. Significant loss of muscle mass has been observed in elderly people with low albumin levels. Hypoalbuminemia is a mortality prognostic factor in elderly people, whether they live in the community or they are in hospital or institutionalized.
Does low albumin cause edema?
A low albumin level can cause edema or exacerbate edema caused by other factors. Edema fluid tends to follow a gravitational pattern. So if you are...
How does proteinuria cause edema?
Albumin is a protein that functions like a sponge, collecting surplus fluid from the body into the circulation and retaining it until the kidneys e...
What happens when albumin is low?
You may be malnourished if your albumin level is low. It might also indicate that you have hepatic or inflammatory illness. Acute infections, burns...
What does albumin do to the body?
Albumin aids in the retention of fluid in the circulation, preventing it from leaking into other tissues. It also transports things such as hormone...
What is the action of albumin?
ACTION MECHANISM Exogenously injected albumin raises the intravascular system's oncotic pressure, drawing fluids from the interstitial space and lo...
What is the role of critical illness in vascular permeability?
Critical illness alters the distribution of albumin between the intravascular and extravascular compartments , affects the rate of albumin synthesis and increases albumin clearance and degradation. The increased capillary leakage responsible for the vascular permeability is a result of various factors including the effects of cytokines such as TNF-alpha and IL-6, chemokines, the action of prostaglandins and complement components as well as endotoxins from gram-negative bacteria.
What happens when albumin is lost from the intravascular into the extravascular compartments?
Loss of albumin from the intravascular into the extravascular compartments results in hypoalbuminemia.
What causes low albumin levels?
Decreased production of albumin is a rare cause of hypoalbuminemia. Significant and severe chronic hepatic impairment is required before a noticeable decrease in plasma albumin is manifest . Hypoalbuminemia is a feature of chronic and advanced hepatic cirrhosis. Most commonly, inadequate synthesis of albumin in the presence of increased catabolism due to significant systemic illness contributes to an overall hypoalbuminemia
Why is it important to be cognizant of hypoalbuminemia?
It is essential that healthcare workers be cognizant of the impact of hypoalbuminemia in patient outcomes, particularly in the critically ill to ensure that appropriate attention is given to managing both the low albumin as well as the primary pathology.
What is nephrotic range proteinuria?
Nephrotic range proteinuria is considered to be the loss of 3.5 or more grams of protein per 24-hour period. Apart from significant proteinuria, nephrotic syndrome is characterized by hypoalbuminemia, increased edema, and presence of ascites due to the low oncotic pressure.
What are the symptoms of hypoalbuminemia?
Patients with hypoalbuminemia present with peripheral (pitting) and central edema ( ascites and effusions) and anasarca. They may also complain of fatigue and excessive weakness and other features of related nutritional deficiencies, for example, iron deficiency anemia in Celiac disease.
What is the term for a kidney disease that causes albuminuria?
Chronic kidney disease (CKD): One of the definitions of CKD includes the presence of significant albuminuria 30 to 300 mg per 24 hours over at least a period of 3 months. This can occur in the presence or absence of a decreased glomerular filtration rate (GFR). End-stage renal disease (ESRD) is associated with significant proteinuria and albuminuria together with serum hypoalbuminemia. The hypoalbuminemia in ESRD is also a result of the decreased synthesis and increased degradation of protein in this condition. [2]
What are the arrows in the liver?
Solid arrows: transmembrane transport. Dashed arrows: Synthesis in liver; Degradation: intracellular proteolysis. Gain: Increase in total body albumin. Loss: decrease in total body albumin. Reduction: reducing oxidized total boyd albumin. The length of the black oval represents albumin mass, which is diminished due to more rapid intracellular breakdown in liver and proliferating cells. It is uncertain, whether cell volume is stable, while it is certain that cell solids are decreased in inflammatory conditions. Fluxes are represented by the size of arrows crossing the cell walls between liver, plasma, interstitium, and cell. They are larger (higher transmembrane flux) in inflammation than in health. It is possible that only a part of the flux entering the interstitium enters the cell, but rather (especially in inflammation after oxidation or scavenging) turns back to the plasma and is then reduced or degraded in the liver. The size of the quadrangles represents the volume of the different compartments and their grey intensity, the concentration of serum albumin. The size of cell mass in health and inflammatory states have been depicted to be identical although this is uncertain; cell mass may be increased, while cell solids are decreased. In health, net hepatic albumin output enters the plasma, and from there, it gets limited access to the interstitium at a low rate and, subsequently, to the cells. In these compartments, albumin serves as antioxidant and scavenger and to a very limited degree as supplier of amino acids for cell proliferation. Oxidized and otherwise damaged albumin is broken down in the liver or reduced for renewed antioxidation or scavenging. In inflammatory states, these functions are upregulated depending on the severity of the inflammatory insult, increasing fluxes from plasma to interstitium by increased capillary permeability. Albumin synthesis may increase, but oxidation of and scavenging by albumin will be upregulated. Similarly, albumin serves as intracellular amino acid donor for cell proliferation at a much higher rate than in health. Consequently, breakdown of albumin is higher in inflammatory states than in health, leading to decreased albumin mass despite potentially increased synthesis. These processes have been described in the literature, but have not been quantified. Transport into the cell as depicted in Figure 1 may be exaggerated and reentry of serum albumin from the interstitium into the plasma underestimated.
How does albumin affect cell proliferation?
Increased capillary escape of serum albumin may represent a useful mechanism limiting or countering oxidative influences, but also increasing flux of substrate for cell proliferation and deposition of matrix in infection, trauma, and cancer growth. There is evidence that albumin is taken up from the interstitium by rapidly proliferating cancer cells, and is degraded by cell organelles supplying amino acids as building blocks. 86 This especially occurs in nutrient‐deprived states and is regulated by mammalian target of rapamycin complex 1 (mTORC1), controlling protein synthesis. 94 Most of the research has focused on cancer cells, but more recently it has been suggested to be a general mechanism also in noncancerous mammalian cells. 87
What is the relationship between albumin and inflammation?
Hypoalbuminemia is associated with inflammation. Despite being addressed repeatedly in the literature, there is still confusion regarding its pathogenesis and clinical significance. Inflammation increases capillary permeability and escape of serum albumin, leading to expansion of interstitial space and increasing the distribution volume of albumin. The half‐life of albumin has been shown to shorten, decreasing total albumin mass. These 2 factors lead to hypoalbuminemia despite increased fractional synthesis rates in plasma. Hypoalbuminemia, therefore, results from and reflects the inflammatory state, which interferes with adequate responses to events like surgery or chemotherapy, and is associated with poor quality of life and reduced longevity. Increasing or decreasing serum albumin levels are adequate indicators, respectively, of improvement or deterioration of the clinical state. In the interstitium, albumin acts as the main extracellular scavenger, antioxidative agent, and as supplier of amino acids for cell and matrix synthesis. Albumin infusion has not been shown to diminish fluid requirements, infection rates, and mortality in the intensive care unit, which may imply that there is no body deficit or that the quality of albumin “from the shelf” is unsuitable to play scavenging and antioxidative roles. Management of hypoalbuminaemia should be based on correcting the causes of ongoing inflammation rather than infusion of albumin. After the age of 30 years, muscle mass and function slowly decrease, but this loss is accelerated by comorbidity and associated with decreasing serum albumin levels. Nutrition support cannot fully prevent, but slows down, this chain of events, especially when combined with physical exercise.
What is the kinetics of albumin?
The kinetics of albumin are represented in states with low or low normal serum albumin levels, occurring during life events and stress conditions, such as disease, trauma, or organ failure. Hypoalbuminemia is proposed to result from increased capillary permeability and changes in albumin kinetics, necessary to allow substrates to reach areas with increased cell proliferation and matrix deposition. Of the different cytokines, growth factors, or hormones known to steer this beneficial metabolic response, the role of VEGF is emphasized, specifically promoting angiogenesis and capillary permeability and instrumental in this beneficial response. Albumin kinetics have not been thoroughly investigated in all conditions mentioned.
How does albumin change?
A change in the amount of serum albumin also is a function of its rate of breakdown. The breakdown of serum albumin is complicated by the fact that after oxidation, glycation, or binding of pro‐oxidative substances, serum albumin loses its antioxidant capacity and is more rapidly degraded than reduced unbound serum albumin. 79, 80, 81, 82, 83 The degradation of serum albumin is influenced by changes in charge and hydrophobicity. In the review of Iwao et al, 82 it was suggested that this probably is affected by endocytosis in the liver, but a receptor has not yet been identified. However, there is evidence in rapidly proliferating cells in cancer that serum albumin can be transported into cells and cell organelles, where it can be degraded to its component amino acids acting as building blocks. 84, 85, 86, 87, 88 Finally, in nephrotic syndrome and protein‐losing enteropathy, serum albumin is lost via urine or stools, respectively. Taken together, these findings support the possibility that in stressed conditions, the half‐life of albumin becomes shorter, in part due to accelerated breakdown. A short half‐life of albumin (if present) and increased losses in urine or stools lead to a decrease in total body albumin mass unless compensated by increased synthesis. A comparable mechanism occurs in muscle in stressed states, where protein synthesis increases but degradation increases even more, leading to net muscle efflux of amino acids that serve as building blocks for synthesis of protein and other nitrogen‐containing products in wound healing and in the liver and other parts of the immune system. Simultaneously, muscle cells benefit from this response despite net catabolism of muscle mass. 89, 90 Total serum albumin mass and the distribution volume of serum albumin determine albumin concentrations in serum, the interstitial space, and in cells. In hypoalbuminemia, the ratio between plasma and interstitial serum albumin mass may be normal at 2:3 or slightly increased. 91 If true, this would imply that a decrease in plasma albumin mass signifies that total serum albumin mass is also decreased. Unfortunately, such a calculation cannot be made because intracellular serum albumin concentrations and transmembrane transport are unknown. In view of the large size of the cellular compartment (>150% of interstitial volume), even low intracellular concentrations may cause large calculation errors. Further study of cell composition and function in the inflammatory state is necessary.
What is the response to vascular permeability?
Increased vascular permeability for cells and plasma solutes is a universal reaction in trauma, critical illness, chronic disease, life events, multiple or isolated organ failure, and cancer. This response is evident in circumstances including edema in healing wounds and the necessity to maintain intravascular volume by “overhydrating” traumatized or postsurgery patients. Adequately resuscitated patients are maintained in a positive fluid balance of 5–10 liters after clean elective major surgery or other types of trauma. 4 Fluid resuscitation is necessary in these circumstances to avoid hypovolemia and the development of shock. The same happens in children after burns, where fluid balance is positive despite the effort to prevent overhydration. 5 The fact that fluid retention inevitably and visibly occurs in wounds as well as at the whole‐body level after trauma and burns could reflect that this response is beneficial to some extent, but may become harmful when the inflammatory stimulus cannot be adequately overcome or treated. 6, 7 In wounds, virtually every type of immune cell appears, producing cytokines and growth factors that support the healing process. Increased cytokine expression does not only happen after trauma or infection, but also in physiologic states including pregnancy and other situations where increased cell proliferation and matrix deposition are required. 8, 9, 10
Is low albumin level bad for surgery?
Hypoalbuminemia represents a risk factor for medical treatment. It has long been known that patients in intensive care suffering from shock, infection, or trauma react inadequately to a renewed challenge like surgery. This has also been called the phenomenon of the second hit. 126, 127, 128, 129, 130, 131 Despite not always appreciating the precise cause of the connection with inflammation, many surgeons know that a low serum albumin level is a bad omen for outcome after surgery. 100, 132, 133, 134, 135, 136, 137, 138 The problem is apparently due to the preexistent inflammatory state, compromising a further adequate inflammatory response after surgery. To improve outcome, treatment should be directed primarily to decrease inflammation by eliminating the inflammatory cause. This is especially relevant when dealing with infection before embarking on a surgical approach. If this is impossible, eg, in the presence of generalized peritonitis or abscesses, acute surgical intervention is required. However, the surgical approach should be adapted, avoiding extensive oncologic surgery or the construction of hazardous intestinal anastomoses, but instead only trying to achieve “damage control.” 100, 128, 139 This may include drainage of abscesses or removal of infected, damaged, or ischemic tissues. When this approach is successful, nutrition support becomes effective, promoting fat‐free mass (muscle) and adequate healing after eventual reoperation, for instance, to restore gastrointestinal continuity and to close the abdominal wall. 100, 139 It should be noted that with successful treatment of the cause of the inflammatory response, patients will lose weight due to reduction of edema and to fluid loss, but will regain function. In addition, full recovery and normo‐albuminemia will only be reached after months. A restorative reoperation should be postponed at least 6–12 weeks.
What happens if you don't have enough albumin?
Hypoalbuminemia happens when you don’t have enough of the protein albumin in your bloodstream. Albumin is a protein that’s made in your liver. It’s an important protein in the plasma of your blood. Depending on your age, your body needs anywhere between 3.5 and 5.9 grams per deciliter (g/dL). Without enough albumin, your body can’t keep fluid ...
How to treat hypoalbuminemia?
You can often treat hypoalbuminemia by raising your albumin levels back to normal. Treatment may vary if a specific condition is causing your hypoalbuminemia.
What causes capillary leak?
This condition is referred to as capillary leak or third spacing. Hypoalbuminemia usually happens in combination with not getting enough protein or calories in your diet. Other common causes of hypoalbuminemia include: getting a serious burn. having a vitamin deficiency. malnutrition and not eating a well-balanced diet.
How much albumin is needed to keep fluid from leaking out of blood vessels?
Depending on your age, your body needs anywhere between 3.5 and 5.9 grams per deciliter (g/dL). Without enough albumin, your body can’t keep fluid from leaking out of your blood vessels. Not having enough albumin can also make it harder to move important substances throughout your body.
What is the CRP test?
The C-reactive protein (CRP) blood test is especially useful for diagnosing hypoalbuminemia. The CRP test can tell your doctor how much inflammation is happening in your body. Inflammation is one of the most important indicators of hypoalbuminemia.
What is the C-reactive protein test?
Kidney damage can cause albumin to leak into your urine. The C-reactive protein (CRP) blood test is especially useful for diagnosing hypoalbuminemia.
What are the complications of hypoalbuminemia?
Hypoalbuminemia can you put you at risk of developing other conditions, including: pneumonia. pleural effusion, which happens when fluid builds up around your lungs. ascites, which happens when fluid builds up in your abdominal area. atrophy, which is significant weakening of the muscles.
