Differential Diagnosis for Low Albumin, A/G Ratio, and High Alk Phos
- Single most likely diagnosis:
- Cirrhosis: This condition often leads to decreased albumin production due to liver dysfunction, a low albumin to globulin (A/G) ratio due to increased globulin production in response to liver disease, and elevated alkaline phosphatase (alk phos) levels due to cholestasis or bone involvement.
- Other Likely diagnoses:
- Nephrotic Syndrome: Characterized by heavy proteinuria, leading to low albumin levels. The A/G ratio is low due to the loss of albumin, and alk phos can be elevated in some cases due to secondary hyperparathyroidism.
- Malnutrition: Can cause low albumin levels due to inadequate protein intake, a low A/G ratio if there's also inflammation, and elevated alk phos from bone turnover in the setting of osteomalacia or rickets.
- Chronic Liver Disease (e.g., hepatitis): Similar to cirrhosis, chronic liver diseases can lead to decreased albumin production, altered A/G ratio, and elevated alk phos due to liver inflammation and cholestasis.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Vitamin D Deficiency: Can lead to elevated alk phos due to secondary hyperparathyroidism and bone disease. While less directly linked to low albumin and A/G ratio, severe deficiency can have widespread effects.
- Malignancy (e.g., liver or bone metastases): Can cause elevated alk phos, low albumin due to malnutrition or liver involvement, and an altered A/G ratio due to paraproteins or chronic disease.
- Sarcoidosis: A systemic disease that can cause elevated alk phos due to granulomatous involvement of the liver or bones, and low albumin with an altered A/G ratio due to chronic inflammation.
- Rare diagnoses:
- Alpha-1 Antitrypsin Deficiency: A genetic disorder leading to liver disease, which can cause low albumin, altered A/G ratio, and elevated alk phos.
- Wilson's Disease: A genetic disorder causing copper accumulation in the liver, leading to liver dysfunction (low albumin, altered A/G ratio) and elevated alk phos.
- Primary Biliary Cholangitis (PBC): An autoimmune disease of the liver that can lead to cholestasis, elevated alk phos, and changes in albumin and globulin levels due to chronic liver disease.