FAQ • hypoalbuminemia

FAQ - hypoalbuminemia
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what is the cause of hypoalbuminemia in patients with pulmunary tuberculosis?

Albumin is a major protein in the human body, making up about 60% of total human plasma protein by mass. Many hormones, drugs, and other molecules are mostly bound to albumin in the bloodstream and must be released before becoming biologically active.

Albumin is synthesized in the liver, and low serum albumin may be indicative of liver failure or diseases such as cirrhosis or chronic hepatitis. Hypoalbuminemia can also present as part of the nephrotic syndrome, in which protein is lost in the urine due to kidney damage. Low albumin levels can be an indicator of chronic malnutrition.

Hypoalbuminemia may cause generalized edema (swelling) via a decrease in oncotic pressure.

The serum albumin level is part of a standard panel of liver function tests. Levels below 3.5 grams per deciliter are generally considered low.

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What is the prognosis for infantile nephrotic syndrome? Where can I get info on this disease?

I have a 8mos old patient with generalized swelling, scanty urination and presently with pneumonia and diarrhea. Labs show hypoalbuminemia, hypercholesterolemia, proteinuria and microcytic hematuria. Patient is septic but getting better with cefipime and IV fluids. We plan to give pulse steroids and get kidney biopsy once patient is better. I can only find a handful of info regarding this conition. pls help

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where info? Lots of info out there. Personally, I've not dealt with peds patients with this rare disorders.

http://www.merck.com/mmhe/sec11/ch144/ch144c.html

http://www.emedicine.com/med/topic1612.htm

http://patients.uptodate.com/topic.asp?file=pedineph/8148

http://www.kidney.org/atoz/atozItem.cfm?id=53 (+ info)

DOES ANYONE KNOW ABOUT "THIRD SPACING" during PREGNANCY?

I was "third spacing" during my THIRD pregnancy due to severe hypoalbuminemia & a kidney/protein (almost pre-eclampsia) problem. When I delivered I had clouds of albumin in my urine too I still have HUGE ankles and some calf swelling a year later. Does ANYONE have any ideas...or anywhere I can read up on it? Thanks.......I have been to many MD's and due to all my labs they can't figure it out.......I am striving for annny answers......;-) Thanks Again!

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Third spacing is where extra fluids go into your tissues from your blood (as seen in your swollen ankles). Usually unknown why during prg. Most of the time it is usually due to your kidney's being unable to process the extra fluid volume (your blood volume increases significantly in prg). Low protein (albumin) in your blood will increase third spacing. Protein (particularly albumin) pulls fluid from the tissues into your blood stream where the kidneys can remove it. Protein is a large molecule and if excreted by the kidneys can damage the delicate kidneys filtration system.
To learn about this more try Medscape.com You may have to register but it is a free web site. (+ info)

I have an unusual question about ABO Incompatibility if anyone can answer?

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A rheumatologist usually can treat autoimmune diseases, and perhaps this condition as well. Hope it turns out well for her. (+ info)

Question about ABO incompatibility (NOT RH FACTOR)?

I have posed this be4 but Mom is still not able to get the help she needs....so please....anyone? Thank u Here Goes:

Mother: Type O +
Father: Type A +
Infant: Type A+
Mother wound up having high fever and aches in the joints so bad she couldn't move 1 month into the pregnancy and began to blow up with with severe generalized Anasarca (THIRD-SPACING) and severe dependent edema with Hypoalbuminemia and VISIBLE Albumin in the urine foley cath AFTER DELIVERY. Has anyone EVER heard of this? Mother is now sick with a Nephrotic Syndrome and still has a huge amount of dependent edema from knee to ankle (resembles elephantiasis) and infant is 1 year old. No MD can figure this out. Where would you suggest she start looking as far as a provider that may specialize in this type of possible immune response?? Thanks!
low b/p so no they didn't think it was full-blown this time .....tho... Mom had pre-eclampsia 2x before. They DO FEEL THERE IS an underlying disorder like LUPUS and possibly even a tumor....so wow u r right on the $$$$$$.....Thank You!!!! If u think of annnything pls let me know...;-)

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Wow - that sounds very strange!

I'd suggest you get a referral to see a renal physician (kidney doctor) and an Immunologist.

This does not sound like a straight-forward complication of blood incompatability to me.

Did the OBGYN team not think it was Pre-Eclampsia? (+ info)

Calling Nurses - Doctors - med. profs. - Pumpkin Orange Urine question -?

Pumpkin orange urine with what appears to be copius LARGE white billowy cloud-like masses floating in a foley 6 hours post c-section...........any ideas on just the presentation? The patient had hypoalbuminemia pre-surgery..........Thanks!
Thank u "The Mom".....u have answered my questions in the past........the patient is ME.....I am a nurse also however I am two years into this awful "whateveritisihave" and ZERO M.D. has been able to help....but I just remembered that I saw pumpkin orange urine and huge white clouds in my foley post third c-sect and I asked every nurse & they all said....don't worry ...probably an infection and you are on ab therapy.........I had NEVER seen that color or the clouds flowing thru either in ANY patient I had........thank you so kindly for trying to help me though!!!!!!! I appreciate everything!

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The one thing that can give an orange color to urine like you describe would be bilirubin- which of course you would not want to see in urine at all. That indicates a liver and kidney problem. The cloudiness could represent the protein being lost from the kidneys, but it would take lab analysis to say if this is protein, calcium or a massive infection. Providing that she hasn't taken any medications known to cause urine color changes, the orange color isn't a real good thing to see. Neither is the excessive cloudiness or the history of hypoalbuminemia, really. Since your patient was pregnant, it could also be that she has gallstones which have blocked the hepatic ducts. This is definitely one for the doctor to sort out.

Edit - I have seen both color and clouds in foley bags and collected UA's before, but it's never been a good sign to be honest with you. It's always been in cases of terminal cirrhosis or liver CA. The only way to know for sure what was up would be to actually have done a culure and analysis of the urine at the time- and I'm assuming that wasn't done?? Shame, if it wasn't. I had to go back to review your previous questions, to refresh my memory. Did you ever get to a specialist in auto-immune diseases? I'm still inclined to think it was the pregnancy that set matters off, and because that is rare you may well have trouble finding a definitive answer. The stress on the liver and kidneys might have caused them to filter out too much albumin- and that would look cloudy in urine. But without the lab, there's no way to know. Sorry I can't offer any more than before- this one is still way out on the edges of my knowledge library. The only other thing I can think of is autoimmune hepatitis, and that's another one on the edge of things for me. But it's another idea to research maybe. Good luck dear, hope you find an answer. (+ info)

POST C-SECTION LYMPHEDEMA...med profs & peeps?......?

ANYONE HAVE IT?....KNOW ANYONE THAT HAS IT? I was third spacing with hypoalbuminemia and SEVERE anasarca my entire pregnancy culminating in my third c-section and with the Anasarca gained over 100 lbs !!!! My second husbands blood type is A+.....I am O+...the baby is A+.....I know....NO RH FACTOR....but a medical professional suggested some sort of insult to my "system" as a whole from the blood type differences??????? I also had pre-eclampsia & 9 months after giving birth my ankles are like clydesdales even though I have lost most of the weight...........HELP! The MD's have NO CLUE.....keep gasping and directing me to clinics where there are 6 month waits to see a specialist. YES....I am A NURSE but am unfamiliar with THIS particular subject. Thank You all so much for any help.......I am so depressed that this may be permanent!!!
Hi....just learned tonite that a vascular surgeon is probably the first step....but looking up "Lymphedema"..........it says.....never goes away....I am so scared....Thank U for your empathy!!!!
Hi...also wanted to add that if I elevate my legs for 12 hours or so 3/4 of the swelling goes down ...I shiver all night and urinate every half hour though and as soon as I stand up....I have 10 minutes to take a shower and my ankles are the same again......haven't been able to wear shoes in 18 months. The Anasarca happened within the first 30 days of my pregnancy and my legs were cement right to my hips......NO medical professional cared.....they all said DON'T WORRY...it'll go away.....yeah....RIGHT!!!!
The baby has no problems except a malformed 5th toe on his right foot that is fixing itself....other than that ....THANK GOD.....no fetal hydrops or anything of that nature. I think u r on to something as I am an immune MESS with psoriatic arthritis and mild psoriasis. My liver enzymes were very whacked and so was anything pertaining to my kidneys .....I( really think they overlooked alottttttt. I think I had nephrotic syndrome of some sort and that case you know of sounds JUST like me. One thing stood out though....a note in the chart written by an MD...."Patient is a NURSE....take strict I & O's...patient VERY aware".......NICE HUH!!! While I am laying there like an elephant with noooooo EXPLANATION. I can't believe that these MD's haven't a CLUE and don't care to follow up with me and help me out with a proper specialist....at VERY least it should be highly interesting to them....you'd think......I had every nursing student aghast......??? Thank You sooo very much 4 all your care!!
also.....they did tell me to terminate as soon as I had the anasarca......but that is all they told me and since I would never....I suffer now....because they REALLY have no CLUE. I have met MD's from overseas that know a little more but still no one with a solid clinical pic......Thanks so much though it all helps!
"The MOM"....You are onto SOMETHING here. I spoke with an immunologist in the hospital and he says it is so rare......that it is really only documented ONE TIME in JAMA. It has something to do with a weird antigen in my husb.'s A+ blood and the fact that the baby took it on annnnd also my severely suppressed immune system. He said from the pics of my ankles that it DOES look like Lymphedema and in most cases that requires lifelong therapy however in my case it MAY resolve once the immune response is suppressed. I will update tomorrow......and TINA thank YOU.......I have been hitting your site for a year now.....;-)......Thanks soooo much!!!!

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You didn't say if the baby had any problems at birth, like a hemolytic disorder. I know that the most famous intereaction is the Rh factor, but there are also disorders associated when the fetal blood is of a different type than the mother, and carries antibodies the mother doesn't have. But those more commonly cause a problem for the baby, not the mother. I have seen one case of something similar to what you are describing, many years ago when I worked L&D. The doctors said she was allergic to pregnancy. When I pressed them further for an explaination, it seemed to me that nobody really had a clue either. It wasn't an allergic response as you would expect to see, but obviously there was something the body didn't like. She also had severe adenopathy, and pre-eclampsia. Her liver enzymes were off the charts, and the internist felt she was at risk for liver or kidney failure. That part sorted itself out shortly after she delivered, but as I recall, she left the hospital still pretty puffed up from the anasarca. She was referred to an internist, and unfortunately I never heard any more after that. But you sound much the same as she did. The doctors all seemed to feel it was a generalized reaction against the pregnancy, and advised her not to repeat it. So it may be the blood difference is enough to set off your immune response. In the days before good prenatal care, I suspect women with your similar problem would not carry them to term, and probably did lose the baby early on. Since the problem would go away in a fairly short time, the rest of the problems just never manifested themselves. I think if I were you I'd just keep at the specialists until somebody came up with a suggestion. If nothing else, perhaps they could try an immune supressant, and see if that wouldn't help matters. Maybe if they calm the immune system, the lymphedema would resolve itself. Good luck- sorry I can't give you more help that this.

edit- I just had another stray thought, after I read your updates and you mentioned you already suffered other autoimmune problems. Look into Angioimmunoblastic Lymphadenopathy with Dysproteinemia. (AILD) is a progressive immune system disorder possibly caused by viral infections, chronic stimulation of immune responses or drug treatments prescribed for other conditions. It's more common in the over 50 set, but that's no reason you couldn't have developed it earlier. NIH has an allergy/immunology section that might be able to come up with some answers for you. Try this link:

Internet: http://www.niaid.nih.gov/

I really think that it is quite likely to be related to the autoimmune response you have already had, and might explain why you reacted to the pregnancy related changes in hormones, etc. I think the baby having a different blood type probably is what set it all in motion. Now the notes I have on the AILD all mention a fine macropapular rash as a most common symptom- and you don't mention having that. Those it might even be hard to spot with severe enough edema, I think. This may not be your trouble, but I would be the farm somebody in the NIH would know more than the average doctor, especially the usual gyn. They just wouldn't run into it often enough to really know what was up. I hadn't even seen or heard of another case until I saw your question on YA, and it brought back the memory. Good luck, and I am glad to hear that at least the baby had a dear face and bare buns, with no other problems than a toe. And who looks at toes anyway? Long as there were five, heaven knows I've seen some odd toes in my career! (+ info)

MEDICAL COMMUNITY - symptoms question? PLEASE HELP!?

Current Symptoms:
Frequent Nocturia (every 1.5 hours)
Sometimes pt. has feeling of passing out in middle of night and is incontinent at the same time.
Numbness/tingling in lower back/flank area when standing (feeling of insects crawling or water trickling...alleviated upon resting/sitting).
Very SWOLLEN Ankles & calves AKIN to Lymphedema (appearence of baseballs on outside of ankles).
Occasional metal-ish taste in mouth (very infrequent)
Numbness and tingling in fingers (intermittent)
Burning on bottom of feet.
*********PRIOR to all this - 3 weeks into a pregnancy pt. had fever of 105 and severe joint pain for 4 days after which the swelling in ankles and calves began.
Pt. gained 150lbs during pregnancy and left hospital using walker. Legs and abdomen felt like cement to the touch for 4 months after delivery.
*********Pt. suffered from severe hypoalbuminemia during pregnancy.
*********ALL current LABS : NORMAL except for slight anemia and HIGH Reticulocyte count. Kidney function and LFT's = Normal
*********Abd./Pelvic CAT SCAN = Normal
*********All Cardiac testing = Normal
*********B/P= 100/60

PLEASE HELP.....I HAVE BEEN TO SO MANY DOCTORS AND NO ONE CAN PROPERLY DIAGNOSE ME. THEY KEEP SENDING ME TO OTHER SPECIALISTS WHO ARE CLUELESS. I AM A NURSE AND AM SUFFERING GREATLY. I HAVE 3 KIDS WHO NEED ME AND MOST OF MY DAY IS SPENT IN BED. Is there anyone out there who knows of a good clinic or place I can go. I have Blue Cross EPO PPO and do not need referrals. I live on Long Island, New York and can get to Manhattan etc. THANK YOU AND GOD BLESS U FOR READING THIS!!! - Terri (I have pictures of my ankles/feet - it is SEVERE)
I am sorry....forgot to mention ....I am on no medication and haven't been at all except for the antibiotics right after delivery.

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Two things from what you wrote:

numbness/tingling - could be a sign of nerve problems - ie. compression of a disk. You would need to see a neurologist.

Frequent incontinence and nocturia can also be associated with spinal problems; also, have you had a bladder scan and bladder volume done? a small bladder and/or functional problems could be a cause.

I would also want to look at arterial and venous dysfunction and lymphatic dysfunction.

Why aren't you are on lasix for the edema?

At this point I would recommend a neurologist first - spinal problems could cause these problems. Then a specialist in auto-immune problems and an endocrinologist (high retic count for no known reason)

But I do wonder why you are in bed all day - you really need to keep moving - even just a little, to keep the fluid moving. Also, you don't list your weight -- being over weight/obese can all contribute to these problems.

Good luck (+ info)

ANyone ever hear of a Mother suffering ABO incompatibility effects?

Mother: Type O +
Father: Type A +
Infant: Type A+
Mother wound up having high fever and aches in the joints so bad she couldn't move 1 month into the pregnancy and began to blow up with with severe generalized Anasarca and severe dependent edema with Hypoalbuminemia and Albumin in the urine. Has anyone EVER heard of this. Mother is now sick with Nephrotic Syndrome and still has a huge amount of dependent edema and infant is 1 year old. No MD can figure this out. Where would you suggest she start looking as far as a provider that may specialize in this type of immune response?? Thanks!
thank u Jen L. No prior HX except pre-eclampsia with every pregnancy which COULD be leading the deteriorization of the kidneys but it does sound like a weird ABO reaction. This is her second partner and 1st child with him. Her first partner was O+. The doctors are working up a possible Lupus DX?? I still can't find ANY info on all this....Thank U though!
mayo? not a bad idea Jen L.......Thank U

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Wow, that's weird!!

Maybe refer to an autoimmune specialist? I've never heard of anything like that before. No similar symptoms pre-pregnancy?

ETA: Lupus? Wow. Then they'd better call in an autoimmune specialist. I've never heard of ABO setting off lupus. How odd! Maybe time to send her to the Mayo clinic? (+ info)

HELP with a Mystery Diagnosis - Odd symptoms - Please Help!!!?

3 weeks into a pregnancy:
.
Massive Anasarca
Fever 104
Joint Pain so bad could hardly move.
Fever and Joint Pain lasted 3-4days
Anasarca continued and worsened until delivery.
Patients Calf and ankle size doubled.
Patients swelling severe right up to the abdomen. Fingers swollen like sausages.
Severe Hypoalbuminemia
((Blood Type O+ & Spouse A+ - Baby born healthy with A+))
(((****Patient felt herself that it was some sort of allergic reaction))
.
Fast Forward 2 years:
Patients Calves and Ankles still severely swollen although the abdomen and thighs seem to have resolved.
Patients Kidney function - resolved.
CT Scan w/dye Abd. & Pelvis -unremarkable
EKG - NSR
Vascular Doppler - neg.
Echo- unremarkable
.
ABNORMAL LABS:
HSCRP- 22.20
CORTISOL (8AM)- 2.3
SED RATE - 47

The patient is still experiencing all over body swelling. Calves and Ankles =appearance of Lymphedema & patient has trouble walking and feels burning pain & sometimes numbness in back.....however sometimes the entire swelling goes way down considerably all over atypical of lymphedema??? Patient elevates thru the nite and has polyuria thru the nite disrupting sleep. ANY IDEAS?????? We have 7 specialists looking into all of it and they are suggesting an underlying Collagen/Connective Tissue Disorder.......but nothing definitive after batteries of tests,,,,,Please Help with thoughts if you can......THANK YOU!!

******Patient admitted to hospital for further testing - on this day some redness was nited in the lower legs & even though cellulitis was ruled out ...."Zosyn" was hung for three days & patients legs came down considerably the following week and have stayed this way for a month.

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