High albumin may indicate dehydration. Look for increase in hemoglobin, hematocrit in such patients.

Low albumin is found with use of I.V. fluids, rapid hydration, overhydration; cirrhosis, other liver disease, including chronic alcoholism; in pregnancy and with oral contraceptive use; many chronic diseases including the nephrotic syndromes, neoplasia, protein-losing enteropathies (including Crohn disease and ulcerative colitis), peptic ulcer, thyroid disease, burns, severe skin disease, prolonged immobilization, heart failure, chronic inflammatory diseases such as the collagen diseases and other chronic catabolic states.

Starvation, malabsorption, or malnutrition: In the absence of I.V. fluid therapy and in patients without liver or renal disease, low albumin may be regarded as an indication of inadequate body protein reserves. It is described as the most common nutrition-related abnormality in patients with infection.¹ Serum albumin has a half-life of about 18-20 days. Its half-life is decreased in patients with catabolic states: infection and with protein loss through the kidneys (eg, nephrosis), gastrointestinal tract, and skin (eg, burns). Its prognostic application is most useful in patients with weight loss, anorexia, stress, surgical therapy, hemorrhage, and infection. Total iron binding capacity <240 μg/dL¹ and/or low transferrin levels would support an impression of inadequate protein reserves. Absolute lymphocyte counts <1500/mm³ may also be seen with protein malnutrition.² In severe malnutrition, albumin has been reported as <2.5 g/dL, total lymphocytes as <800/mm³ and TIBC as <150 μg/dL.²

Albumin levels ≤2.0-2.5 g/dL may be the cause of edema (eg, nephrotic syndrome, protein-losing enteropathies).

Albumin, prealbumin, and transferrin are regarded as “negative” acute phase reactants (ie, these proteins decrease with acute inflammatory/infectious processes).

Low albumin values are associated with longer hospital stay.¹