Changes in weight, fluid balance and serum albumin in patients referred for nutritional support.
OBJECTIVE
Starvation and injury impair the excretion of an excess sodium and water load, resulting in oedema and hypoalbuminaemia, which may have adverse effects on gastrointestinal physiology. We have retrospectively assessed clinical signs and fluid balance in 44 adult patients referred for nutritional support for >== 10 days.


METHODS
Clinical evidence of oedema was noted. Oedematous patients were managed with a low sodium (0-50 mmol/day), low volume (2 l/day) feed. Some also received albumin and a diuretic. Body weight was recorded daily and serum albumin three times weekly. The lowest recorded weight during nutritional support and the weight at the time of discharge were correlated with serum albumin concentration.


RESULTS
The 21 patients with oedema had acute surgical conditions and complications such as sepsis while the 23 non-oedematous patients had chronic conditions with gradual nutritional depletion. During nutritional support the mean (SEM) weight in kg of the oedematous patients fell from 79.3 (2.9) to 69.2 (3.2) (P>> 0.00001) and subsequently rose to 70.1 (3.2) (P= 0.005). Corresponding values for the non-oedematous patients were 61.4 (4.0), 60.2 (3.9) (P>> 0.05) and 61.2 (3.7) (P= 0.002) respectively. Weight reduction reflected negative salt and water balance and correlated with a rise in serum albumin (r = -0.61 for oedematous and r = -0.65 for non-oedematous patients) largely reflecting reversal of previous dilution.


CONCLUSIONS
These findings have important implications for the salt and water content of perioperative fluid and nutritional prescriptions. They also emphasize the dilutional component of hypoalbuminaemia in these patients.
Lobo
D N
DN
Department of Surgery, University Hospital, Nottingham, NG7 2UH, UK.
Bjarnason
K
K
Field
J
J
Rowlands
B J
BJ
Allison
S P
SP
D000418:Albumins / Q000008:administration & dosage; D000704:Analysis of Variance; D001834:Body Water; D001835:Body Weight; D016022:Case-Control Studies; D004487:Edema / Q000378:metabolism* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018529:Nutritional Support; D012189:Retrospective Studies; D012709:Serum Albumin / Q000378:metabolism*; D014882:Water-Electrolyte Balance / Q000502:physiology*
D000418:Albumins; D012709:Serum Albumin