Hypoalbuminemia: Pathophysiology and Management

Hipoalbuminemia, characterized by low blood albumin levels (<3.5 g/dL), is more indicative of physiological stress from one or more diseases rather than nutritional deficiency. It is commonly observed in hospitalized, critically ill, and elderly patients and is associated with poor functional status, longer hospital stays, and increased morbidity and mortality. The main causes include reduced albumin production, increased albumin loss through kidneys, gastrointestinal tract, skin, or extravascular space, and increased albumin catabolism. Management involves identifying the cause and providing oral or parenteral albumin supplementation. Parenteral albumin is recommended in specific conditions such as post-paracentesis cirrhosis with ascites >5 liters, hepatorenal syndrome, spontaneous bacterial peritonitis, and burns >30% after the first 24 hours. In cases of sepsis, acute respiratory failure, major non-cardiac surgery, and cardiac surgery, parenteral albumin may be considered if hemodynamic stability cannot be achieved with crystalloids. However, it is not recommended for maintenance fluid or initial resuscitation in acute head trauma patients.