Re: [Cnm] FW: value of ordering prealbumin to assess nutritionalstatus?

[Guest guest]

Plus, what are they learning in regards to adjusted body weights!

Theresa Gilbert

88 MDG, WPAFB, OH

________________________________

To: Jo Lynn Worden ; " Zoll,

"

Cc: serve

Sent: Thursday, December 11, 2008 9:49:44 AM

Subject: Re: [Cnm] FW: value of ordering prealbumin to assess nutritionalstatus?

I'm curious what most internships are teaching these days regarding IBW and

UBW.  Are the newbies learning the correct way and us " seasoned " RDs are behind

the times--or vice versa?

 

a Tripp MS RD LDN

Clinical Nutrition Manager

PinnacleHealth

Department of Food and Nutrition Services

111 S. Front Street

burg PA  17101

rtripp@...

________________________________

From: cnm-bounces@... On Behalf

Of Jo Lynn Worden

Sent: Wednesday, December 10, 2008 10:05 PM

To: 'Pam Charney'; 'Zoll, '

Cc: 'serve'

Subject: Re: [Cnm] FW: value of ordering prealbumin to assess nutritionalstatus?

I would also like to point out something else – the BMI needs to be used with

caution.  Weight can be affected by dehydration, fluid overload, and sometimes

the patient has just been lean all his life!  And sometimes the weight is just

estimated – and I’ve warned the dietitians, if they don’t have a weight they

really feel has been done correctly, don’t document BMI >40 or <19 or you run

the risk of fraud if the coders use that information.

Ideal body weight also bugs me a lot – I am more interested in a person’s usual

body weight when I am assessing nutritional status.  I can’t tell you how many

times I’ve said that to our dietitians and how little I see usual body weight

documented.

 

 

From:cnm-bounces@... On Behalf

Of Pam Charney

Sent: Wednesday, December 10, 2008 10:02 AM

To: Zoll,

Cc: serve

Subject: Re: [Cnm] FW: value of ordering prealbumin to assess nutritional

status?

 

You do not need the labs to document ICD codes. You need an accurate definition

of what you mean when you say " malnutrition " . If all you use is albumin and/or

prealbumin, you won't be accurate in coding, which is another problem with

potentially very expensive repercussions. 

 

Remember also that levels of hepatic proteins are maintained until fairly late

in the patient with uncomplicated starvation. So, if we use the traditional

model of disease identification (the test is positive, the disease is there, the

test is negative and the disease isn't there), we'd miss diagnosing cases.

 

Food for thought; maybe it's time to change that paradigm?

 

pam

 

 

Pam Charney PhD, RD

Clinical Coordinator

Graduate Coordinated Program in Dietetics

Lecturer, Department of Epidemiology

Nutrition Sciences Program

School of Public Health and Community Medicine

Box 353410, 306-C Raitt Hall

 

Affiliate Associate Professor

School of Pharmacy

 

MS Student

Clinical Informatics and Patient Centered Technology

School of Nursing

 

University of Washington

Seattle, WA

charnepa@...

" The person who says it can't be done should not 

interrupt the person doing it " - Ethel Kennedy

 

In the hospital setting we need albumin or prealbumin to document ICD codes in

our assessments. We have been able to get $4000 additional reimbursement in some

cases. Our hospital is pleased with these results.

 

________________________________

From:cnm-bounces@... On Behalf

Of Pam Charney

Sent: Wednesday, December 10, 2008 10:42 AM

To: CNM@... serve

Cc: lynn Skipper; Hornick, G.

Subject: Re: [Cnm] FW: value of ordering prealbumin to assess nutritional

status?

Agree, there are a couple papers that describe the problems with using serum

hepatic protein levels to assess nutrition status. The first is by Gabay, NEJM,

in I think 1999. The second is by Furhman, J Am Diet Assoc, 2004. 

 

pam

 

Pam Charney PhD, RD

Clinical Coordinator

Graduate Coordinated Program in Dietetics

Lecturer, Department of Epidemiology

Nutrition Sciences Program

School of Public Health and Community Medicine

Box 353410, 306-C Raitt Hall

 

Affiliate Associate Professor

School of Pharmacy

 

MS Student

Clinical Informatics and Patient Centered Technology

School of Nursing

 

University of Washington

Seattle, WA

charnepa@...

" The person who says it can't be done should not 

interrupt the person doing it " - Ethel Kennedy

 

At this point, I see no reason to use albumin or prealbumin to define

malnutrition.   A dietitian can measure the patient’s height and weight,

calculate a BMI, define malnutrition based on a BMI < 18, and move forward.  A

dietitian may also measure the patient’s weight, obtain a weight history, and

assess weight change over time. 

Albumin and prealbumin levels less than normal correlate with mortality. 

However, the investigators who do these studies typically do not report intake

of protein  or other nutrients.  Therefore there isn’t much direct evidence in

sick people that low levels are/are not related to intake of protein or other

nutrients.

Regards,

lynn

From: Hornick, G.  

Sent: Tuesday, December 09, 2008 1:56 PM

To: cnm@...

Subject: [Cnm] FW: value of ordering prealbumin to assess nutritional status?

If someone answered this, would you please repost?  Thanks.

Hornick, RD, LD

Chief Clinical Dietitian

FSH/MMMHC