Re: Prealbumin and albumin?

[Guest guest]

Haven't used albumin as a screening tool or marker in years. Too much changes

based on hydration, fluid, recent surgery, even head injuries knock it down.

Chronic malnutrition will actually show stable NORMAL albumin/pre-albumin.

 

Pre-Albumin will be checked by pharmacy when starting nutrition support, but it

does not dictate my recommended protein provision because

pre-albumin is suppressed in acute infectious process.  My recommendations

are usually at the maximum needed anyway (see below) given the medical

condition of the patient.

 

I make my protein recommendations based on est needs for healthy, renal (pre or

on dialysis), wounds/surgical repair/burns, and growth (pediatrics). More

protein doesn't translate to increased albumin/pre-albumin if already receiving

2 g/kg (adults) - 3.5 g/kg (infants).

 

Holly

----------

Holly Lee Brewer, MS RD

Pediatric Dietitian, Diabetes Educator

Medical Nutrition Therapist, Las Vegas, NV

Maj Holly Brewer, USAFR BSC

301st MDS, NAS Fort Worth JRB (Carswell), TX

http://hollyinbalad.blogspot.com

>To: " rd-usa " <rd-usa >

>Sent: Tuesday, July 3, 2012 11:55 AM

>Subject: Prealbumin and albumin?

>

>

> 

>Are you all still using the following guidelines for albumin levels?

>Are you still using albumin and prealbumin at all for protein need flags?

>

>Condition

>

>Albumin Level Per Lab gm/dl

>

>Protein Requirement (gm/kg/day)

>

>Normal Nutrition

>

>3.9

>

>3.5

>

>3.2

>

>3.0

>

>0.8 - 1.0

>

>Mild Depletion

>

>3.1 - 3.8

>

>2.8 - 3.4

>

>2.6 - 3.1

>

>2.4 - 2.9

>

>1.2

>

>Moderate Depletion

>

>3.0 or less

>

>2.7 or less

>

>2.5 or less

>

>2.3 or less

>

>1.2 - 1.5

>

>Severe Depletion

>

>2.4 or less

>

>2.1 or less

>

>1.9 or less

>

>1.7 or less

>

>1.5 - 2.0

>

> W. Rowell, RD, LN, CLT

>Montana State Hospital

>Long-term Care Consultant

>

>

[Guest guest]

Haven't used albumin as a screening tool or marker in years. Too much changes

based on hydration, fluid, recent surgery, even head injuries knock it down.

Chronic malnutrition will actually show stable NORMAL albumin/pre-albumin.

 

Pre-Albumin will be checked by pharmacy when starting nutrition support, but it

does not dictate my recommended protein provision because

pre-albumin is suppressed in acute infectious process.  My recommendations

are usually at the maximum needed anyway (see below) given the medical

condition of the patient.

 

I make my protein recommendations based on est needs for healthy, renal (pre or

on dialysis), wounds/surgical repair/burns, and growth (pediatrics). More

protein doesn't translate to increased albumin/pre-albumin if already receiving

2 g/kg (adults) - 3.5 g/kg (infants).

 

Holly

----------

Holly Lee Brewer, MS RD

Pediatric Dietitian, Diabetes Educator

Medical Nutrition Therapist, Las Vegas, NV

Maj Holly Brewer, USAFR BSC

301st MDS, NAS Fort Worth JRB (Carswell), TX

http://hollyinbalad.blogspot.com

>To: " rd-usa " <rd-usa >

>Sent: Tuesday, July 3, 2012 11:55 AM

>Subject: Prealbumin and albumin?

>

>

> 

>Are you all still using the following guidelines for albumin levels?

>Are you still using albumin and prealbumin at all for protein need flags?

>

>Condition

>

>Albumin Level Per Lab gm/dl

>

>Protein Requirement (gm/kg/day)

>

>Normal Nutrition

>

>3.9

>

>3.5

>

>3.2

>

>3.0

>

>0.8 - 1.0

>

>Mild Depletion

>

>3.1 - 3.8

>

>2.8 - 3.4

>

>2.6 - 3.1

>

>2.4 - 2.9

>

>1.2

>

>Moderate Depletion

>

>3.0 or less

>

>2.7 or less

>

>2.5 or less

>

>2.3 or less

>

>1.2 - 1.5

>

>Severe Depletion

>

>2.4 or less

>

>2.1 or less

>

>1.9 or less

>

>1.7 or less

>

>1.5 - 2.0

>

> W. Rowell, RD, LN, CLT

>Montana State Hospital

>Long-term Care Consultant

>

>

[Guest guest]

As Holly says, there are too many other factors that can make albumin low

besides protein malnutrition.  Pre-albumin in combination with CRP is

helpful.  If CRP is high and pre-albumin is low, it's likely that it's

inflammation and not malnutrition that is causing a low pre-albumin.  If CRP is

normal or low and pre-albumin is low, then malnutrition is likely.  It is rare

that I have seen this situation, but I have seen it in a patient with anorexia

and in a few other patients with very low intake.

 

- Lyn

Subject: Re: Prealbumin and albumin?

To: " rd-usa " <rd-usa >

Date: Tuesday, July 3, 2012, 2:33 PM

 

Haven't used albumin as a screening tool or marker in years. Too much changes

based on hydration, fluid, recent surgery, even head injuries knock it down.

Chronic malnutrition will actually show stable NORMAL albumin/pre-albumin.

 

Pre-Albumin will be checked by pharmacy when starting nutrition support, but it

does not dictate my recommended protein provision because

pre-albumin is suppressed in acute infectious process.  My recommendations

are usually at the maximum needed anyway (see below) given the medical

condition of the patient.

 

I make my protein recommendations based on est needs for healthy, renal (pre or

on dialysis), wounds/surgical repair/burns, and growth (pediatrics). More

protein doesn't translate to increased albumin/pre-albumin if already receiving

2 g/kg (adults) - 3.5 g/kg (infants).

 

Holly

----------

Holly Lee Brewer, MS RD

Pediatric Dietitian, Diabetes Educator

Medical Nutrition Therapist, Las Vegas, NV

Maj Holly Brewer, USAFR BSC

301st MDS, NAS Fort Worth JRB (Carswell), TX

http://hollyinbalad.blogspot.com

>To: " rd-usa " <rd-usa >

>Sent: Tuesday, July 3, 2012 11:55 AM

>Subject: Prealbumin and albumin?

>

>

> 

>Are you all still using the following guidelines for albumin levels?

>Are you still using albumin and prealbumin at all for protein need flags?

>

>Condition

>

>Albumin Level Per Lab gm/dl

>

>Protein Requirement (gm/kg/day)

>

>Normal Nutrition

>

>3.9

>

>3.5

>

>3.2

>

>3.0

>

>0.8 - 1.0

>

>Mild Depletion

>

>3.1 - 3.8

>

>2.8 - 3.4

>

>2.6 - 3.1

>

>2.4 - 2.9

>

>1.2

>

>Moderate Depletion

>

>3.0 or less

>

>2.7 or less

>

>2.5 or less

>

>2.3 or less

>

>1.2 - 1.5

>

>Severe Depletion

>

>2.4 or less

>

>2.1 or less

>

>1.9 or less

>

>1.7 or less

>

>1.5 - 2.0

>

> W. Rowell, RD, LN, CLT

>Montana State Hospital

>Long-term Care Consultant

>

>

[Guest guest]

As Holly says, there are too many other factors that can make albumin low

besides protein malnutrition.  Pre-albumin in combination with CRP is

helpful.  If CRP is high and pre-albumin is low, it's likely that it's

inflammation and not malnutrition that is causing a low pre-albumin.  If CRP is

normal or low and pre-albumin is low, then malnutrition is likely.  It is rare

that I have seen this situation, but I have seen it in a patient with anorexia

and in a few other patients with very low intake.

 

- Lyn

Subject: Re: Prealbumin and albumin?

To: " rd-usa " <rd-usa >

Date: Tuesday, July 3, 2012, 2:33 PM

 

Haven't used albumin as a screening tool or marker in years. Too much changes

based on hydration, fluid, recent surgery, even head injuries knock it down.

Chronic malnutrition will actually show stable NORMAL albumin/pre-albumin.

 

Pre-Albumin will be checked by pharmacy when starting nutrition support, but it

does not dictate my recommended protein provision because

pre-albumin is suppressed in acute infectious process.  My recommendations

are usually at the maximum needed anyway (see below) given the medical

condition of the patient.

 

I make my protein recommendations based on est needs for healthy, renal (pre or

on dialysis), wounds/surgical repair/burns, and growth (pediatrics). More

protein doesn't translate to increased albumin/pre-albumin if already receiving

2 g/kg (adults) - 3.5 g/kg (infants).

 

Holly

----------

Holly Lee Brewer, MS RD

Pediatric Dietitian, Diabetes Educator

Medical Nutrition Therapist, Las Vegas, NV

Maj Holly Brewer, USAFR BSC

301st MDS, NAS Fort Worth JRB (Carswell), TX

http://hollyinbalad.blogspot.com

>To: " rd-usa " <rd-usa >

>Sent: Tuesday, July 3, 2012 11:55 AM

>Subject: Prealbumin and albumin?

>

>

> 

>Are you all still using the following guidelines for albumin levels?

>Are you still using albumin and prealbumin at all for protein need flags?

>

>Condition

>

>Albumin Level Per Lab gm/dl

>

>Protein Requirement (gm/kg/day)

>

>Normal Nutrition

>

>3.9

>

>3.5

>

>3.2

>

>3.0

>

>0.8 - 1.0

>

>Mild Depletion

>

>3.1 - 3.8

>

>2.8 - 3.4

>

>2.6 - 3.1

>

>2.4 - 2.9

>

>1.2

>

>Moderate Depletion

>

>3.0 or less

>

>2.7 or less

>

>2.5 or less

>

>2.3 or less

>

>1.2 - 1.5

>

>Severe Depletion

>

>2.4 or less

>

>2.1 or less

>

>1.9 or less

>

>1.7 or less

>

>1.5 - 2.0

>

> W. Rowell, RD, LN, CLT

>Montana State Hospital

>Long-term Care Consultant

>

>

[Guest guest]

Thanks to both of you. Both comments are helpful!

Happy Independence Day! Remember how our liberty was won and the tool we were

given to maintain it.

W. Rowell, RD, LN, CLT

Montana State Hospital

Long-term Care Consultant

From: rd-usa [mailto:rd-usa ] On Behalf Of Lyn

Woods

Sent: Tuesday, July 03, 2012 3:55 PM

To: rd-usa

Subject: Re: Prealbumin and albumin?

As Holly says, there are too many other factors that can make albumin low

besides protein malnutrition. Pre-albumin in combination with CRP is helpful.

If CRP is high and pre-albumin is low, it's likely that it's inflammation and

not malnutrition that is causing a low pre-albumin. If CRP is normal or low and

pre-albumin is low, then malnutrition is likely. It is rare that I have seen

this situation, but I have seen it in a patient with anorexia and in a few other

patients with very low intake.

- Lyn

From: hl brewer <hlbrewer@...<mailto:hlbrewer%40yahoo.com>>

Subject: Re: Prealbumin and albumin?

To: " rd-usa <mailto:rd-usa%40yahoogroups.com> "

<rd-usa <mailto:rd-usa%40yahoogroups.com>>

Date: Tuesday, July 3, 2012, 2:33 PM

Haven't used albumin as a screening tool or marker in years. Too much changes

based on hydration, fluid, recent surgery, even head injuries knock it down.

Chronic malnutrition will actually show stable NORMAL albumin/pre-albumin.

Pre-Albumin will be checked by pharmacy when starting nutrition support, but it

does not dictate my recommended protein provision because pre-albumin is

suppressed in acute infectious process. My recommendations are usually at the

maximum needed anyway (see below) given the medical condition of the patient.

I make my protein recommendations based on est needs for healthy, renal (pre or

on dialysis), wounds/surgical repair/burns, and growth (pediatrics). More

protein doesn't translate to increased albumin/pre-albumin if already receiving

2 g/kg (adults) - 3.5 g/kg (infants).

Holly

----------

Holly Lee Brewer, MS RD

Pediatric Dietitian, Diabetes Educator

Medical Nutrition Therapist, Las Vegas, NV

Maj Holly Brewer, USAFR BSC

301st MDS, NAS Fort Worth JRB (Carswell), TX

http://hollyinbalad.blogspot.com

From: " Rowell, " <drowell@...<mailto:drowell%40mt.gov>>

>To: " rd-usa <mailto:rd-usa%40yahoogroups.com> "

<rd-usa <mailto:rd-usa%40yahoogroups.com>>

>Sent: Tuesday, July 3, 2012 11:55 AM

>Subject: Prealbumin and albumin?

>

>

>

>Are you all still using the following guidelines for albumin levels?

>Are you still using albumin and prealbumin at all for protein need flags?

>

>Condition

>

>Albumin Level Per Lab gm/dl

>

>Protein Requirement (gm/kg/day)

>

>Normal Nutrition

>

>3.9

>

>3.5

>

>3.2

>

>3.0

>

>0.8 - 1.0

>

>Mild Depletion

>

>3.1 - 3.8

>

>2.8 - 3.4

>

>2.6 - 3.1

>

>2.4 - 2.9

>

>1.2

>

>Moderate Depletion

>

>3.0 or less

>

>2.7 or less

>

>2.5 or less

>

>2.3 or less

>

>1.2 - 1.5

>

>Severe Depletion

>

>2.4 or less

>

>2.1 or less

>

>1.9 or less

>

>1.7 or less

>

>1.5 - 2.0

>

> W. Rowell, RD, LN, CLT

>Montana State Hospital

>Long-term Care Consultant

>

>

[Guest guest]

Thanks to both of you. Both comments are helpful!

Happy Independence Day! Remember how our liberty was won and the tool we were

given to maintain it.

W. Rowell, RD, LN, CLT

Montana State Hospital

Long-term Care Consultant

From: rd-usa [mailto:rd-usa ] On Behalf Of Lyn

Woods

Sent: Tuesday, July 03, 2012 3:55 PM

To: rd-usa

Subject: Re: Prealbumin and albumin?

As Holly says, there are too many other factors that can make albumin low

besides protein malnutrition. Pre-albumin in combination with CRP is helpful.

If CRP is high and pre-albumin is low, it's likely that it's inflammation and

not malnutrition that is causing a low pre-albumin. If CRP is normal or low and

pre-albumin is low, then malnutrition is likely. It is rare that I have seen

this situation, but I have seen it in a patient with anorexia and in a few other

patients with very low intake.

- Lyn

From: hl brewer <hlbrewer@...<mailto:hlbrewer%40yahoo.com>>

Subject: Re: Prealbumin and albumin?

To: " rd-usa <mailto:rd-usa%40yahoogroups.com> "

<rd-usa <mailto:rd-usa%40yahoogroups.com>>

Date: Tuesday, July 3, 2012, 2:33 PM

Haven't used albumin as a screening tool or marker in years. Too much changes

based on hydration, fluid, recent surgery, even head injuries knock it down.

Chronic malnutrition will actually show stable NORMAL albumin/pre-albumin.

Pre-Albumin will be checked by pharmacy when starting nutrition support, but it

does not dictate my recommended protein provision because pre-albumin is

suppressed in acute infectious process. My recommendations are usually at the

maximum needed anyway (see below) given the medical condition of the patient.

I make my protein recommendations based on est needs for healthy, renal (pre or

on dialysis), wounds/surgical repair/burns, and growth (pediatrics). More

protein doesn't translate to increased albumin/pre-albumin if already receiving

2 g/kg (adults) - 3.5 g/kg (infants).

Holly

----------

Holly Lee Brewer, MS RD

Pediatric Dietitian, Diabetes Educator

Medical Nutrition Therapist, Las Vegas, NV

Maj Holly Brewer, USAFR BSC

301st MDS, NAS Fort Worth JRB (Carswell), TX

http://hollyinbalad.blogspot.com

From: " Rowell, " <drowell@...<mailto:drowell%40mt.gov>>

>To: " rd-usa <mailto:rd-usa%40yahoogroups.com> "

<rd-usa <mailto:rd-usa%40yahoogroups.com>>

>Sent: Tuesday, July 3, 2012 11:55 AM

>Subject: Prealbumin and albumin?

>

>

>

>Are you all still using the following guidelines for albumin levels?

>Are you still using albumin and prealbumin at all for protein need flags?

>

>Condition

>

>Albumin Level Per Lab gm/dl

>

>Protein Requirement (gm/kg/day)

>

>Normal Nutrition

>

>3.9

>

>3.5

>

>3.2

>

>3.0

>

>0.8 - 1.0

>

>Mild Depletion

>

>3.1 - 3.8

>

>2.8 - 3.4

>

>2.6 - 3.1

>

>2.4 - 2.9

>

>1.2

>

>Moderate Depletion

>

>3.0 or less

>

>2.7 or less

>

>2.5 or less

>

>2.3 or less

>

>1.2 - 1.5

>

>Severe Depletion

>

>2.4 or less

>

>2.1 or less

>

>1.9 or less

>

>1.7 or less

>

>1.5 - 2.0

>

> W. Rowell, RD, LN, CLT

>Montana State Hospital

>Long-term Care Consultant

>

>

[Guest guest]

Neither lab value should be used to determine nutritional status. The best way

to assess patients is to use a validated tool such as the Subjective Global

Assessment.

Regards,

pam

Pam Charney, PhD, RD

HIT Pro Clinician/Practitioner Consultant

Affiliate Associate Professor

Pharmacy

MS Student

Clinical Informatics and Patient Centered Technology

School of Nursing

University of Washington

Seattle, WA

pcharney@...

http://www.linkedin.com/in/pamcharney

> Are you all still using the following guidelines for albumin levels?

> Are you still using albumin and prealbumin at all for protein need flags?

>

> Condition

>

> Albumin Level Per Lab gm/dl

>

> Protein Requirement (gm/kg/day)

>

> Normal Nutrition

>

> 3.9

>

> 3.5

>

> 3.2

>

> 3.0

>

> 0.8 - 1.0

>

> Mild Depletion

>

> 3.1 - 3.8

>

> 2.8 - 3.4

>

> 2.6 - 3.1

>

> 2.4 - 2.9

>

> 1.2

>

> Moderate Depletion

>

> 3.0 or less

>

> 2.7 or less

>

> 2.5 or less

>

> 2.3 or less

>

> 1.2 - 1.5

>

> Severe Depletion

>

> 2.4 or less

>

> 2.1 or less

>

> 1.9 or less

>

> 1.7 or less

>

> 1.5 - 2.0

>

> W. Rowell, RD, LN, CLT

> Montana State Hospital

> Long-term Care Consultant

>

>

[Guest guest]

Neither lab value should be used to determine nutritional status. The best way

to assess patients is to use a validated tool such as the Subjective Global

Assessment.

Regards,

pam

Pam Charney, PhD, RD

HIT Pro Clinician/Practitioner Consultant

Affiliate Associate Professor

Pharmacy

MS Student

Clinical Informatics and Patient Centered Technology

School of Nursing

University of Washington

Seattle, WA

pcharney@...

http://www.linkedin.com/in/pamcharney

> Are you all still using the following guidelines for albumin levels?

> Are you still using albumin and prealbumin at all for protein need flags?

>

> Condition

>

> Albumin Level Per Lab gm/dl

>

> Protein Requirement (gm/kg/day)

>

> Normal Nutrition

>

> 3.9

>

> 3.5

>

> 3.2

>

> 3.0

>

> 0.8 - 1.0

>

> Mild Depletion

>

> 3.1 - 3.8

>

> 2.8 - 3.4

>

> 2.6 - 3.1

>

> 2.4 - 2.9

>

> 1.2

>

> Moderate Depletion

>

> 3.0 or less

>

> 2.7 or less

>

> 2.5 or less

>

> 2.3 or less

>

> 1.2 - 1.5

>

> Severe Depletion

>

> 2.4 or less

>

> 2.1 or less

>

> 1.9 or less

>

> 1.7 or less

>

> 1.5 - 2.0

>

> W. Rowell, RD, LN, CLT

> Montana State Hospital

> Long-term Care Consultant

>

>

[Guest guest]

Neither lab value should be used to determine nutritional status. The best way

to assess patients is to use a validated tool such as the Subjective Global

Assessment.

Regards,

pam

Pam Charney, PhD, RD

HIT Pro Clinician/Practitioner Consultant

Affiliate Associate Professor

Pharmacy

MS Student

Clinical Informatics and Patient Centered Technology

School of Nursing

University of Washington

Seattle, WA

pcharney@...

http://www.linkedin.com/in/pamcharney

> Are you all still using the following guidelines for albumin levels?

> Are you still using albumin and prealbumin at all for protein need flags?

>

> Condition

>

> Albumin Level Per Lab gm/dl

>

> Protein Requirement (gm/kg/day)

>

> Normal Nutrition

>

> 3.9

>

> 3.5

>

> 3.2

>

> 3.0

>

> 0.8 - 1.0

>

> Mild Depletion

>

> 3.1 - 3.8

>

> 2.8 - 3.4

>

> 2.6 - 3.1

>

> 2.4 - 2.9

>

> 1.2

>

> Moderate Depletion

>

> 3.0 or less

>

> 2.7 or less

>

> 2.5 or less

>

> 2.3 or less

>

> 1.2 - 1.5

>

> Severe Depletion

>

> 2.4 or less

>

> 2.1 or less

>

> 1.9 or less

>

> 1.7 or less

>

> 1.5 - 2.0

>

> W. Rowell, RD, LN, CLT

> Montana State Hospital

> Long-term Care Consultant

>

>

[Guest guest]

Thanks, everyone. This is really helpful. Local doctors are still looking at

these labs to determine status for LTC and subacute patients--as an RD I have

stopped using them, now I have more reasons why not. This will be a great

educational tool for others I come in contact with.

Regards,

Marilyn Jess, MS, RD

[Guest guest]

Thanks, everyone. This is really helpful. Local doctors are still looking at

these labs to determine status for LTC and subacute patients--as an RD I have

stopped using them, now I have more reasons why not. This will be a great

educational tool for others I come in contact with.

Regards,

Marilyn Jess, MS, RD

[Guest guest]

I fully agree with all these comments re: albumin, pre-albumin, and CRP. My

question is how to convince doctors, nurses, and even state surveyors that these

are not appropriate nutritional markers?? I am becoming frustrated explaining

these basics (when CRP is high, pre-alb is low, etc) over and over! Any good

succinct research papers I can hand over to residents and interns?

Thank You,

Berry, MS, RD

Healdsburg District Hospital

Clinical Dietitian

(707)431-6426