Albumin is the most abundant protein circulating in the blood plasma, and its primary function is to maintain the body’s fluid balance. It achieves this by exerting oncotic pressure, which keeps fluid inside the blood vessels and prevents it from leaking into surrounding tissues. Hypoalbuminemia is the medical term for an abnormally low concentration of albumin in the bloodstream, typically defined as below 3.5 grams per deciliter. This condition is a sign of an underlying health issue, which must be correctly identified for effective treatment.
Understanding the Root Causes
Effective management depends on pinpointing the specific mechanism responsible for the deficit. The causes of hypoalbuminemia are generally grouped into categories based on how the body’s albumin balance is disrupted.
Decreased Production
One mechanism is decreased production, as the liver is the sole site of albumin synthesis. Conditions such as advanced chronic liver disease or cirrhosis can severely impair the liver’s ability to manufacture this protein.
Increased Loss
Increased loss of albumin often occurs in kidney disorders like nephrotic syndrome. When the kidney’s filtration units become damaged, they allow large protein molecules like albumin to leak into the urine (proteinuria). Significant losses can also happen through the gastrointestinal tract (protein-losing enteropathy) or damaged skin, such as in severe burn injuries.
Redistribution and Dilution
Albumin levels can also drop due to increased utilization or redistribution during acute illness or inflammation. In severe systemic inflammation, such as sepsis, cytokines cause albumin to move out of the blood vessels and into the surrounding tissues. A dilutional effect can also temporarily lower albumin concentration following excessive intravenous fluid resuscitation.
Targeted Treatment of Underlying Conditions
Since hypoalbuminemia is a symptom, the most sustainable treatment is managing the underlying disease causing the protein imbalance.
Liver Disease Management
For chronic liver disease, this involves managing complications. Interventions include administering intravenous albumin and antibiotics to prevent or treat spontaneous bacterial peritonitis (SBP). Albumin infusion is also used during large-volume paracentesis (removal of excess fluid from the abdomen) to prevent a drop in circulating blood volume.
Kidney Disease Management
In patients experiencing excessive protein loss through the kidneys, managing the underlying kidney disease is the main focus. Medications such as Angiotensin-Converting Enzyme (ACE) inhibitors or Angiotensin II Receptor Blockers (ARBs) are prescribed to reduce the amount of protein filtered out of the blood. These drugs work by lowering the pressure within the kidney’s filtering structures, minimizing albumin loss into the urine.
Inflammation Control
Controlling systemic inflammation is important for improving albumin levels in people with inflammatory conditions or acute critical illness. This may involve using corticosteroids or other immunosuppressive drugs to reduce the inflammatory response that drives albumin out of the bloodstream. Successfully treating a severe infection, like sepsis, with targeted antimicrobial therapy can quickly resolve the inflammatory state and allow albumin levels to stabilize.
Direct Albumin Supplementation and Symptom Management
In certain acute situations, direct supplementation with intravenous albumin is necessary to quickly stabilize a patient’s condition. This temporary measure involves infusing human-derived albumin directly into the bloodstream. The purpose is to restore oncotic pressure inside the blood vessels, which rapidly pulls excess fluid back from the tissues.
Intravenous albumin is most commonly used for acute volume expansion in cases of shock or during procedures like large-volume paracentesis in liver disease. It is also employed with diuretic medications to mobilize refractory edema, where fluid buildup in the tissues is severe and resistant to standard water pills alone. The goal is to shift the fluid into the circulation so the kidneys can excrete it, effectively treating the fluid overload.
However, intravenous albumin is generally reserved for specific, medically defined indications and is not a generalized treatment for chronic low albumin. If the underlying cause is not addressed, the administered albumin will quickly be lost or redistributed, making the infusion’s effect temporary. For chronic nutritional hypoalbuminemia, the focus is on sustained dietary improvement rather than repeated IV infusions.
Nutritional and Lifestyle Support
Supportive care through diet is a foundational element in managing hypoalbuminemia, especially when malnutrition is a contributing factor. Adequate dietary protein intake provides the necessary amino acids the liver requires to synthesize new albumin. High-quality protein sources, such as lean meats, fish, eggs, dairy products, and legumes, are encouraged to optimize this production.
A general guideline for many adults with low albumin is to aim for a protein intake between 1.2 and 1.5 grams per kilogram of body weight each day. Careful consideration must be given to patients with existing kidney disease, as excessive protein intake can sometimes place a strain on the remaining kidney function. A registered dietitian can provide personalized guidance to ensure protein goals are met without causing harm.
Lifestyle adjustments, particularly managing fluid and sodium intake, are also important for controlling the symptoms of low albumin. Because low oncotic pressure causes fluid to leak into the tissues, patients often develop swelling in the legs (edema) or abdomen (ascites). Restricting dietary sodium helps reduce fluid retention, and monitoring total fluid intake is often necessary to prevent or manage fluid overload alongside medical treatments like diuretics.