What causes a sudden decrease in albumin and total protein levels?

From the Guidelines

A sudden drop in albumin and total protein levels can be caused by acute inflammation or infection, which redirects protein synthesis away from albumin toward acute phase reactants, as supported by a recent study published in 2021 1. This condition can lead to a rapid decrease in protein production, and it is essential to identify the underlying cause to provide appropriate management. Some possible causes of a sudden drop in albumin and total protein levels include:

• Acute liver disease, such as hepatitis or liver failure, which can rapidly decrease protein production since the liver is the primary site of albumin synthesis
• Severe kidney disease, particularly nephrotic syndrome, which can cause significant protein loss through the urine
• Malnutrition or protein-losing enteropathy from gastrointestinal disorders like inflammatory bowel disease or celiac disease, which can also lead to decreased protein levels
• Severe burns or extensive skin conditions, which may cause protein loss through the skin
• Hemorrhage or blood loss, which dilutes remaining proteins, while overhydration or IV fluid administration can cause hemodilution
• Pregnancy, which can naturally lower albumin levels due to increased plasma volume According to a study published in 2021 1, albumin levels decline during the acute phase inflammatory response due to alterations in visceral protein homeostasis, regardless of nutritional status. Therefore, it is crucial to seek immediate medical attention if a sudden drop in albumin and total protein levels is detected, as it may indicate a serious underlying condition requiring prompt treatment. The specific cause will determine the appropriate management approach, which might include addressing the underlying disease, nutritional support, or medication adjustments, as recommended by a guideline published in 2024 1.

From the Research

Causes of Sudden Drop in Albumin and Total Protein

• Several diseases can cause a sudden drop in albumin and total protein, including:
  • Cirrhosis 2
  • Malnutrition 2
  • Nephrotic syndrome 2, 3, 4, 5
  • Sepsis 2
• Change in posture, such as assuming a recumbent position, can also cause a significant decrease in serum albumin levels within a few days of hospitalization 6
• Increased permeability to proteins at the level of the glomerulus, allowing for passage of albumin and other proteins into the urine, can lead to hypoalbuminemia and a drop in total protein 3
• Dietary protein intake can affect albumin metabolism in nephrotic patients, with high protein intake potentially increasing glomerular permeability to macromolecules and leading to further albumin loss in the urine 5

Clinical Scenarios

• Patients with cirrhosis and spontaneous bacterial peritonitis, patients with cirrhosis undergoing large volume paracentesis, and patients with type 1 hepatorenal syndrome may require intravenous albumin supplementation 2
• Patients with nephrotic syndrome may experience thromboembolic events even with relatively high albumin levels 4
• Burn patients, patients with hemorrhagic shock, and patients undergoing therapeutic plasmapheresis may also require albumin supplementation, although it may not be a first-choice treatment in these cases 2