title: Physiologic hypoalbuminemia is well tolerated by severely burned children.
abstract: 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.
authors.affiliation: Shriners Burns Institute, Massachusetts General Hospital, Boston 02114, USA. sheridan@helix.mgh.harvard.edu
authors.forename: R L
authors.initials: RL
authors.lastname: Sheridan
authors.forename: K
authors.initials: K
authors.lastname: Prelack
authors.forename: J J
authors.initials: JJ
authors.lastname: Cunningham
mesh_terms: D000293:Adolescent; D000328:Adult; D000418:Albumins / Q000008:administration & dosage*; D002053:Burn Units; D002056:Burns / Q000097:blood* / Q000503:physiopathology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D004750:Enteral Nutrition; D006801:Humans; D007223:Infant; D012709:Serum Albumin / Q000172:deficiency*; D012712:Serum Globulins / Q000172:deficiency
chemical_list: D000418:Albumins; D012709:Serum Albumin; D012712:Serum Globulins