HYPOALBUMINEMIA IN

COMBUSTION

ARIEF MUNANDAR
Intensivist
DONT FORGET IN PATIENT MANAGEMENT

• WHAT HAS HAPPENED ?

• WHAT IS HAPPENING ?

• WHAT WILL HAPPEN ?

 INTRODUCTION
• Albumin is the main protein synthezised by the
liver and has several important function.It is
essential in the maintenance of normal plasma
koloid oncotic pressure and is the primary
serum binding protein responsible for the
transport of various substances in the circulation
including fatty acids,hormones and drugs.
• Normal reference range for albumin is 35-45 g/l

Int J Burn Trauma 2013;3(3):159-163

INTRODUCTION...
• The determination of albumin level is not
sensitivity and specifity indicator of protein
nutrition state.
• Serum albumin is a reliable indicator of
morbidity and mortality in hospitalized
patients.
INTRODUCTION...
• Preoperative with mild hypoalbuminemia
associated with postoperative mortality and
morbidity in 0 – 30 days.
• Hypoalbuminemia in colorectal
(gastrointestinal), cancer, and case with
comorbids,contributes significantly to poor
postoperative outcome.

Hu et al.Nutrition Journal (2019) 18 : 33

INTRODUCTION...
• Severe hypoalbuminemia is a strong
independent risk factor for acute respiratory
failure in COPD.

• Hypoalbuminemia is associated with

increased mortality in patients with COPD.

Dovepress.International Journal of COPD.17 june 2015

INTRODUCTION...
• Importantly, whatever the underlying mechanisms,
hypoalbuminemia is associated with worse outcomes
including increased complication and reduced short-
term and longer-term of survival and death.
• In a meta-analysis of 90 cohorts studies that had
evaluated hypoalbuminemia as a prognostic biomarker
in acuttely ill patients, each 10 g/l decrease serum
albumin was associated with a 137% increase in the
odds of death, and 89% increase in morbidity, and 71%
increase in length of hospital stay.
Journal of Parenteral and Enteral Nutrition;43(2)
2019:181-193
INTRODUCTION...
• Each 0,25 g/dl decreased in serum albumin is
associated with 24%-56% increased in
mortality.
• ≤ 2 g/ dl concentration of serum albumin,
closely with 100% of mortality.
 ALBUMIN IN BURN INJURY
• Globally, advances in treating burns have
significantly changed the clinical course of a
patient’s recovery,increasing the chance of
survival.
• The mortality rate remains high,especially in
rural and underdeveloped country.
• The probability of death can be predicted
from clinical factors, especially serum
albumin level. CLINICS 2013;68(7):940-945
 PATOPHYSIOLOGY
• Hypoalbuminemia is common in critically ill
patients,particularly in burn patients.
• Even when burns cover < 10% of the body
surface, important metabolic changes
occur.Burn produce hypermetabolic and
hypercatabolic responses, which are related
to the extent and depth of the injuries.
PATOPHYSIOLOGY...
• Burn affecting of the body surface cause a major
loss of extracellular fluids, thereby inducing
shock by increasing vascular permeability and
reducing plasma albumin from the wound
exudations.
• Acut phase response of plasma protein syntesis in
liver occur with even a very small percentage of
burn skin (0,8%) and that produces a decrease to
about 80% of normal albumin and prealbumin
level.
PATOPHYSIOLOGY...
• Be considered at least one serum albumin level
determination in first 3 days after burn injury, because
is the highhest catabolic phase of the burn patients and
when serum albumin level drop in burn people,this
phase covers the first 2 weeks after burn injury.
• The levels of liver albumin and prealbumin synthesis
decreased to about 80% of normal after 24 h of the
burn injury, and the losses of albumin through the burn
wound are greatest in the first 3 postburn days.After 3
days,protein loss in all burn types decreased to a
relatively steady state.
 CONCLUSION
• Serum albumin levels are not a nutritional marker
and shouldn”t be used to asses the nutritional
protein status.
• The measurement of serum albumin levels at first
3 days period after the burn injury could be used
as a simple clinical tool to identify the severity of
the burn wound patients.
• Whatever underlying
mechanism,hypoalbuminemia is associated with
worse outcomes.
 CASE
• Tn. RUS,Laki-laki 63 th,masuk icu dari ibs tgl 23-
7-2022,post op laparatomi,ec perforasi gaster.
• VS saat masuk, TD 130/80,N 120x,gcs
E4V4M6 ,rr 28,terpasang drain agak keruh,uo
50-70 cc
• Lab preop hb 9,2,al 25 rb,at 504,ur 214,cr
2,9,na 142,91,k 5,19,cl 108,7.
• Lab post op di icu hb 8,5,al 22,5,at 296,ur
252,cr 2,7, ALBUMIN 1,7.
 CASE
• Pasen Tn.Rus,tgl 22-7-22,masuk igd dng
keluhan nyeri perut. Td 117/60,N 120x/mnt,rr
22x/mnt.
• Urin output tidak terpantau,evaluasi preop
tidak ada.
• Tgl 25-7-22, gcs E4V4M6,Td 111/86,N 128,T
37,8,rr 25-28,spor 98-99%.Lab hb 10,al 5,2,at
134,ur 174,41,cr 1,79, albumin 2,9, uo 0,5
cc/kgbb/jam.
• Tgl 27-7-22,gcs E4V3M6,Td 129/78,N 129,rr
28-33,spo2 96-97%.At 44 rb,Na 165,ur
123,2,cr 1,04,alb 2,9.
• Malam hari pkl 22.00,gagal nafas intubasi on
ventilator. Ro thorax pneumonia,agd ards.
• Tgl 30-7-22,tambah perburukan,gcs turun 8-
10,drain jebol,→ SEPTIC SHOCK.
• Tgl 2-8-22,pkl 12.30 RJP → MENINGGAL pkl
13.20.