How To Treat Low Albumin (Hypoalbuminemia)?

Hypoalbuminemia means abnormally low levels of albumin in the blood. ‘Hypo’ meaning low and ‘albuminemia’ meaning is levels of albumin in blood.

What is Albumin?

Albumin is the most important plasma protein. This protein is also present in eggs. It is synthesized in the liver at the rate of 250mg/kg/day. It is degraded into amino acids. Albumin is present in small amounts in sweat, tear, bile and gastric juices.

Albumin is abundantly present in the interstitial fluid. Since albumin is large, it cannot pass through an intact endothelium. Therefore, it provides the necessary oncotic pressure to allow passage of water and certain solutes through the capillaries. This is the reason why albumin has a negative charge.

Albumin also binds to chloride (〖Chl〗^-) which gives increases its negative charge and also gives albumin the ability to retain sodium (〖Na〗^+). But when endothelium gets disrupted, this oncotic pressure get disturbed and fluid from intravascular spaces moves to interstitial tissue space resulting in edema.

Why is Albumin Important?

• It is responsible for transport of hormones, metals, bilirubin, drugs and certain nutrients.
• Albumin binds to free fatty acids and keeps them in a soluble form in plasma.
• Provides buffer for hydrogen ions, therefore it is essential to maintain pH of blood.
• It is responsible for maintaining oncotic of plasma.
• Serum albumin levels indicate liver function. Falling levels of albumin in chronic liver disease are suggestive of a deteriorating function.
• About 50% of calcium in the blood binds to albumin for transport.
• Albumin has anti-oxidant properties.
• It modulates inflammatory reactions.

Serum albumin is increased only in cases of acute dehydration

Total Serum Proteins: 6-8g/dL

Normal Range of Serum Albumin: 3.5 – 5.0 g/dL
Albumin is an acute phase reactant protein and may be increased in acute infective conditions. However, progressively reducing levels are suggestive of a serious medical condition.

Albumin/ Globulin ratio: This ratio is generally more than 1.
Low albumin/ globulin ratio occurs due to liver cirrhosis, renal dysfunctions, auto-immune diseases and multiple myeloma. The high ratio is found generally in leukemia.

Urine Albumin Levels:
Up to 30 mg – Normal
30-300 mg – Microalbuminuria
More than 300 mg – Macroalbuminuria

What are The Causes of Low Albumin?

1. Mal Absorption Syndromes – This refers to a number of disorders wherein the small intestine is unable to absorb fluid and certain types of nutrients such as vitamins, proteins, carbohydrates and minerals.
2. Chronic Liver Diseases – Such as cirrhosis or hepatitis reduce the synthesis of albumin.
3. Malnutrition
4. Infections or Sepsis
5. Nephritic Syndrome – Characterized by excess loss of albumin, about 3gm daily. It is caused by extensive damage of blood vessels inside the kidneys.
6. Protein Losing Enteropathy – This is a symptom and not an illness. A lot of mechanisms result in loss of serum proteins into the gastrointestinal tract.
7. A lot of plasma along with proteins is lost in cases of burns. This occurs due to abnormally increased vascular permeability due to burn wounds.
8. Cardiac failure.
9. Pre-existing medical conditions like diabetes, hypothyroidism and SLE.

Possible causes of low albumin levels are generally elicited from medical history and physical examination. Performing basic tests for liver and renal function, electrolytes and a urine examination will further aid in finding out the probable cause. Low serum albumin can occur due to more than one underlying cause.

How is it Diagnosed?

Levels of serum proteins are tested by drawing a blood sample. A routine examination of urine also indicates presence/ absence of proteins in urine. C Reactive Protein (CRP) is useful in diagnosing Hypoalbuminemia. CRP is indicative of the extent of inflammation present in the body.

Microalbuminemia or albumin/ creatinine ratio or urine albumin test is done. This is done by routine examination of urine or a 24-hour urine proteins analysis.

What Happens When Albumin Levels are Low?

Albumin constitutes about 60% of the total plasma proteins. It is responsible for transport of all the essential substances needed by our body. Therefore, when serum albumin levels are low, these functions get hampered.

Signs and Symptoms of Low Albumin in Blood are:

1. Edema of limbs and face.
2. Thin hair and dry skin
3. Difficulty in breathing
4. Irregular pulse
5. Changes in appetite and body weight.
6. Pleural effusion or ascites may occur due to extremely low levels of albumin.
7. Whitening of nails is a rare sign of hypoalbuminemia.
8. Microalbuminemia is excretion of small amounts of albumin in urine. Presence of albumin in urine is a sign of renal abnormality. It also occurs in diabetic patients.

Low Albumin in Pregnancy:

Low levels of albumin are seen in women with kidney diseases, hypothyroidism, and malnutrition, protein losing enteropathy or liver diseases.

Levels of Albumin During Pregnancy Are

A small amount of protein in urine is not considered abnormal. However, large amount of proteins in urine suggest the presence of some infection. Such large amounts of protein in the urine during last trimester of pregnancy suggests a more serious medical condition, it may increase the risk of a pregnant woman of developing pre-eclampsia.

Some causes for low albumin during pregnancy are infections, fever, dehydration, medications, pre-eclampsia, strenuous exercise or medical conditions such as cardiac and renal disorders, auto-immune diseases such as systemic lupus erythematosus, leukemia, sickle cell anemia or rheumatoid arthritis.

Alarming Symptoms of Low Albumin in Pregnancy are:

• Blurred vision
• Sudden onset of headache
• High blood pressure
• Nausea and vomiting
• Swelling of face and limbs.

How to Avoid Low Albumin Levels During Pregnancy?

• Maintaining good health and optimum hygiene is of utmost importance during pregnancy, because, it is at this time, that a woman becomes more susceptible to developing infections.
• Avoid extremely sugary food substances, as sugars provide a favourable environment for bacteria to grow.
• Avoid smoking and alcohol consumption.
• Food rich in proteins is helpful as are fresh fruits, vegetables and nuts.
• Avoid processed food and limit caffeine intake.
• Drinking plenty of water during pregnancy is of utmost importance as it frequently flushes the urinary tract. It also maintains adequate hydration.

Management of Low Serum Albumin:

1. Diagnosis and treatment of underlying cause is the first step.
2. A low sodium diet is recommended. Research papers have suggested that albumin levels are low in patients consuming high amounts of salt.
3. Natural sources of albumin – eggs, cheese, nuts and dairy products.
4. Commercially available albumin is given intravenously in terminally ill patients or those in intensive care units, as it is said to maintain organ function.
5. Cessation of tobacco and alcohol consumption.
6. Hypoalbuminemia due to acute illnesses usually resolves along with the illness itself with the help of anti-inflammatory drugs.
7. Immunosuppressant drugs may be prescribed to patients having Systemic Lupus Erythematosus or any other auto-immune diseases.
8. Foods rich in proteins such as legumes, pulses, fish and nuts help in increasing protein levels.
9. Certain food supplements may also be prescribed by the physician.

Albumin is an essential protein for normal functioning of any individual. Therefore, any condition leading to a drop in levels of albumin needs to be corrected immediately.