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Physiologic hypoalbuminemia is well tolerated by severely burned children
R L Sheridan1, K Prelack, J J Cunningham
1Shriners Burns Institute, Massachusetts General Hospital, Boston 02114, USA. sheridan@helix.mgh.harvard.edu
Insights
Physiologic hypoalbuminemia in severely burned children does not negatively impact outcomes. Albumin levels between 1.0-2.5 g/dL are safe, possibly due to increased plasma globulin.
Area of Science:
- Pediatric critical care
- Burn management
- Nutritional support
Background:
- Physiologic hypoalbuminemia (plasma albumin [pl-ALB] 1.0-2.5 g/dL) is part of the injury response.
- Consensus on albumin supplementation for hypoalbuminemia is lacking.
- This study addresses the safety and impact of profound hypoalbuminemia in pediatric burn patients.
Purpose of the Study:
- To evaluate the effects of a protocol tolerating profound physiologic hypoalbuminemia in severely burned children.
- To determine if low plasma albumin levels adversely affect pulmonary function, gut tolerance, wound healing, or overall outcomes.
Main Methods:
- Examined 27 children with >40% body surface burns over 4 weeks.
- Managed patients with an albumin-supplementation protocol allowing pl-ALB < 1.0 g/dL.
- Administered intravenous albumin (1-2 g/kg/d) when pl-ALB fell below 1.0 or 1.5 g/dL, stopping when pl-ALB reached 2.0 g/dL.
Main Results:
- Mean pl-ALB was 1.7 g/dL; 70% required albumin infusion for pl-ALB < 1.0 g/dL.
- Profound hypoalbuminemia was constant, with mean weekly pl-ALB never exceeding 2.5 g/dL.
- Patients tolerated nasogastric feedings, had minimal diarrhea, maintained adequate oxygenation (PaO2/FiO2 >150), healed well, and all survived.
Conclusions:
- Profound physiologic hypoalbuminemia (pl-ALB 1.0-2.5 g/dL) is not associated with adverse effects in severely burned children.
- Compensatory increases in plasma globulin (acute-phase proteins) may mitigate negative impacts.
- This approach supports safe management without routine albumin supplementation for mild-to-moderate hypoalbuminemia.
Background:
Physiologic hypoalbuminemia, defined as a plasma albumin (pl-ALB) of 1.0 to 2.5 g/dL, is a component of the injury response. A consensus on the need for albumin supplementation in this setting is lacking.
Methods:
We examined 27 consecutive children (age, 7 +/- 6 years) with > 40% body surface burns (mean, 59 +/- 18%) during their initial 4 weeks of care. Patients were managed with an albumin-supplementation protocol that tolerated profound physiologic hypoalbuminemia. Intravenous albumin was administered by infusion of 1 to 2 g/kg/d when pl-ALB fell below 1.0 g/dL, or below 1.5 g/dL in the presence of enteral feeding intolerance or pulmonary dysfunction. Supplementation was stopped when pl-ALB reached 2.0 g/dL.
Results:
Mean pl-ALB was 1.7 g/dL overall. Infusion for pl-ALB < 1.0 g/dL was needed for 70% (n = 19) of the patients. Profound physiologic hypoalbuminemia was constant, that is, mean weekly pl-ALB never exceed 2.5 g/dL in any patient. Mean plasma globulin rose during the 4 week period from 2.3 +/- 0.1 at week 1 to 3.1 +/- 0.1 at week 4. Diarrhea was negligible (19 of 756 patient days), nasogastric feedings were well tolerated, PaO2/FiO2 ratios remained well above 150, wounds healed satisfactorily, and all children survived and have been discharged home.
Conclusions:
Profound physiologic hypoalbuminemia (pl-ALB of 1.0-2.5 g/dL) does not have adverse effects on pulmonary or gut function, wound healing, or outcome in severely burned children, perhaps because of a compensatory increase in acute-phase proteins reflected in plasma globulin.