What does a high albumin (protein) level indicate?

High Albumin Levels: Causes and Clinical Significance

High serum albumin levels typically indicate dehydration, which causes hemoconcentration of plasma proteins. 1

Understanding Normal Albumin Levels

• Normal serum albumin range is approximately 3.5-5.0 g/dL, though laboratory-specific ranges may vary 1
• Albumin is the most abundant protein in plasma, synthesized exclusively by the liver 2
• Albumin serves multiple biological functions including maintenance of oncotic pressure, binding and transport of substances (fatty acids, bilirubin, thyroid hormone, drugs), and antioxidant properties 2

Common Causes of Elevated Albumin

• Dehydration (most common cause) - resulting in hemoconcentration of plasma proteins 1
• Resolution of inflammatory conditions - as albumin is a negative acute-phase reactant that increases following recovery from inflammation 1, 2
• Increased protein or energy intake - albumin levels may rise modestly with increased nutritional intake 2, 1

Clinical Evaluation

• Assess hydration status as the primary step - most elevated albumin resolves with proper hydration 1
• Review recent dietary changes, particularly high protein intake 1
• Consider measuring inflammatory markers (e.g., C-reactive protein) to assess if elevated albumin reflects recovery from inflammation 2
• Evaluate for recent weight changes that might indicate fluid shifts 3

Interpreting Albumin Results

• Serum albumin should be interpreted in context of the patient's overall clinical status 2
• Serial monitoring of albumin is more informative than a single measurement 1
• Consider laboratory method variations - bromcresol green method may have different reference ranges than other methods 2

Important Considerations

• Albumin levels are affected by multiple factors beyond nutrition, including inflammation, hydration status, and liver function 2
• In patients with kidney disease, albumin levels can be affected by fluid status - overhydration can cause hemodilution and falsely low levels, while dehydration can cause falsely high levels 3
• Albumin is considered a marker of nutritional status only in clinically stable individuals 2, 4

Common Pitfalls

• Failing to recognize that elevated albumin is usually a sign of dehydration rather than a primary disorder 1
• Not considering the impact of inflammatory conditions on albumin levels 2
• Overlooking the relationship between albumin and hydration status when interpreting results 3
• Misinterpreting albumin levels without considering laboratory method variations 1

When to Be Concerned

• Persistently elevated albumin despite adequate hydration may warrant further evaluation 1
• If accompanied by other abnormal liver function tests, consider evaluation for liver disorders 2

Remember that while low albumin is commonly discussed as a marker of poor outcomes, elevated albumin is most often a reflection of dehydration and typically resolves with proper fluid intake 1.