What causes an increase in albumin (blood protein) levels?

Causes of Increased Serum Albumin Levels

Dehydration is the most common cause of increased serum albumin levels, resulting in hemoconcentration that artificially elevates albumin concentration in the blood. 1

Primary Causes of Hyperalbuminemia

1. Dehydration/Volume Depletion

• Occurs when total body water decreases, causing hemoconcentration
• Common clinical scenarios include:
  • Inadequate fluid intake
  • Excessive fluid losses (vomiting, diarrhea, excessive sweating)
  • Diuretic use
  • Fever
  • Burns

2. Exogenous Albumin Administration

• Intravenous albumin infusions for medical indications 1, 2
  • Large-volume paracentesis (6-8 g albumin per liter of fluid removed)
  • Hepatorenal syndrome
  • Spontaneous bacterial peritonitis
  • Management of chronic liver failure 3

3. Acute Phase Response (Relative Increase)

• While inflammation typically decreases albumin synthesis, the acute phase of inflammation may temporarily increase albumin levels before the typical hypoalbuminemic response occurs 4

Physiological Factors Affecting Albumin Levels

Albumin Production and Regulation

• Albumin is produced exclusively by the liver 1
• Normal production rate is influenced by:
  • Nutritional status
  • Hormonal factors
  • Inflammatory state

Albumin Distribution

• Changes in distribution between intravascular and extravascular compartments can affect measured levels
• Decreased capillary permeability can lead to higher intravascular albumin concentration 5

Clinical Assessment of Elevated Albumin

Evaluation Algorithm

1. Confirm true elevation by repeat testing
2. Assess hydration status:
   • Check vital signs for tachycardia, hypotension
   • Examine mucous membranes, skin turgor
   • Review recent weight changes
   • Assess BUN/creatinine ratio (elevated in dehydration)
3. Review medication history for albumin infusions
4. Consider underlying conditions that might affect albumin metabolism

Common Pitfalls in Interpretation

• Misinterpreting elevated albumin as a sign of improved liver function
• Failing to recognize dehydration as the most common cause
• Not considering the relationship between albumin and hydration status 6
• Overlooking the impact of albumin infusions in patients with liver disease or undergoing procedures 1, 2

Management Implications

• For dehydration-induced hyperalbuminemia:
  • Appropriate fluid rehydration will normalize albumin levels
  • Monitor albumin levels to ensure normalization after rehydration
• For iatrogenic causes (albumin infusions):
  • Recognize expected transient elevation
  • Avoid unnecessary additional testing

Special Considerations

• In patients with liver disease, elevated albumin is rarely physiologic and usually indicates dehydration or recent albumin administration 2
• In dialysis patients, elevated albumin may reflect improved nutritional status or excessive ultrafiltration causing hemoconcentration 1, 6
• Serial measurements are more valuable than single readings for clinical interpretation 1

Understanding the cause of increased albumin levels is essential for proper clinical management, with dehydration being the most common etiology requiring prompt recognition and treatment.