Low albumin symptoms are very common in hospitalized patients, but many people don’t realize that their symptoms are related to low albumin levels. I have treated thousands of hospitalized patients in the last 15 years, and many of them had low albumin symptoms.
In this article, I will review low albumin symptoms based on my personal experience as a doctor as well as a review of relevant medical research articles. By the end of this article you will understand the following:
- What is albumin and how low albumin levels lead to worrisome symptoms
- Who is at risk of low albumin symptoms, and what you can do to help them?
- How low albumin complicates hospitalization
What is albumin, and how do low albumin symptoms develop in your body?
Albumin is a kind of protein that is made by your liver. Albumin is also the main protein found in egg whites. It is a protein that dissolves very well in water. Albumin is normally dissolved in your blood. The normal amount of albumin in the blood is about 3.5 to 5.5 milligrams per deciliter (mg/dl).
Albumin has many functions in your body, but most of the symptoms of low albumin levels are related to its ability to control the amount of water going in and out of your blood vessels. Unlike salt and minerals, albumin does not go in and out of the blood vessels. It stays inside your blood vessels. Since albumin dissolves in water but can’t escape out of the blood vessels, it draws water inside. Without albumin, water will seep out of the blood vessels and cause massive swelling in your body.
When albumin levels in your blood go down, these changes occur:
- Less water inside your blood vessels leads to a low blood volume
- More water outside the blood vessels leads to swelling
If you understand these two processes, you will easily learn about low albumin symptoms.
Low albumin symptoms related to a low blood volume
When your blood volume goes down, you get the following low albumin symptoms listed in order from mild to severe:
- Weakness
- Cold hands and feet
- Decreased capillary refill: Capillaries are the small blood vessels that are present right below your skin. When you press on your skin, you squeeze blood out of these vessels and your skin appears pale for a while. Immediately, blood flows back into the capillaries and your skin goes back to a normal color. This time needed to get your skin back to normal is the capillary refill time. In healthy adults, capillary refill only takes about 2 seconds. If it takes more than 5 seconds, it is regarded as abnormal.
- Feeling tired or sleepy
- Decreased urine
- Increased heart rate
- Feeling dizzy and lightheaded
- Low blood pressure
To have low blood pressure symptoms from low albumin, your albumin needs to be very low. It is very rare to have such a low albumin to cause low blood pressure by itself. However, it is common to get low blood pressure in hospitalized patients with low albumin when they have another disease that may lower the blood pressure too.
Low albumin symptoms related to water seeping out from blood vessels
You can have different degrees of symptoms from the water that seeps out of your blood vessels due to low albumin. Here is the list of those low albumin symptoms in order from mild to severe:
- Swelling of both feet and ankles
- Swelling going up both your legs
- Swelling involving your legs and thighs
- Swelling all the way up to your groin area
- Fluid inside your abdomen
- Fluid inside your chest
- Shortness of breath from too many fluids inside your chest and abdomen
- Swelling of the whole body, including your face.
This type of swelling is called anasarca, and this happens with very low albumin.
Who is at risk of low albumin symptoms, and what can you do to help them?
Low albumin symptoms happen from many different causes. Here are people that are at risk for getting low albumin symptoms:
Elderly people living alone
In these people, the low albumin is caused by malnutrition. Your liver needs protein in the diet to make albumin. When your protein intake goes down, albumin production may suffer. Eventually, elderly people with malnutrition may start to have early signs of low albumin. If left untreated, they can get more severe symptoms.
It is important to check on elderly people to make sure they have access to healthy meals. The elderly are at a very high risk of becoming malnourished. Low albumin symptoms are very important indicators of malnutrition. When you address malnutrition early and feed them healthy meals, you can avoid complications related to malnutrition and low albumin.
People with diseases that interfere with the absorption of nutrition from food
People with certain diseases of the gastrointestinal tract (the stomach and intestines) have problems with properly absorbing nutrients from the food they eat. Examples of such diseases include chronic pancreatitis, Celiac disease, Crohn’s disease, etc. It is important to have a regular follow-up appointment with your doctor and access your nutritional status if you suffer from any longstanding problems related to your stomach and intestines.
People with liver diseases
People with advanced liver diseases are at a very high risk of getting low albumin symptoms. When your liver is damaged, it comes to a point where it is unable to make albumin. The liver is the main organ that controls the production of many important chemicals in the body, including albumin. People with a liver disease often have multiple symptoms from abnormal levels of different chemicals. It is very difficult to treat low albumin associated with a liver disease. For a short-term solution, hospitalized patients with low albumin symptoms may be given albumin through their veins. The albumin given through the veins only lasts a few hours, but this may give some patients a fighting chance while they are struggling with other serious illnesses at the same time.
People with protein loss in the urine
Certain specific kidney diseases make the filters in your kidneys leaky. They start to lose protein, including albumin, in the urine. Read “Excessive protein in the urine: Nephrotic syndrome” to understand the details of how kidneys lose albumin in this condition. The urine of people with leaky kidneys appears frothy and foamy. They lose so much protein that they develop low albumin symptoms very fast. It is not uncommon to see people with this condition present with anasarca or severe swelling involving the whole body.
It is important to identify protein loss in the urine early and try to identify and treat the exact cause of the leaky filters in the kidneys. You can refer to the linked article for details.
How low albumin symptoms complicate hospitalization
When patients are hospitalized for other medical problems, it is more difficult to treat those problems if they also have low albumin. We will look at some common but serious diseases and see how low albumin affects those:
Sepsis
Sepsis is an overwhelming response to an infection. If you would like to learn more about sepsis, you can read “Low blood pressure and a fever: think about sepsis”. Patients with sepsis can get sicker quickly. They can go into shock due to low blood pressure. It is difficult to treat sepsis and septic shock in patients with low albumin. Normally, IV fluids are given to help improve blood pressure in patients with septic shock. When they also have low albumin, it is difficult to keep these extra fluids inside the blood vessels. The fluids leak out and cause more swelling instead of helping the low blood pressure. They may need to be given IV albumin instead of IV fluids.
Internal bleeding
Internal bleeding can cause low blood pressure. If you have low albumin along with internal bleeding, your blood pressure can drop too low too soon. It can be dangerous, and people with low albumin will need extra precautions.
Dehydration
Symptoms of dehydration are harder to recognize in patients with low albumin because low albumin symptoms mask the signs of dehydration. The swelling from low albumin may be confused with excess water in the body instead of dehydration. People with low albumin may become significantly dehydrated and still have the appearance of having excess water in the body. We have to look at the heart rate, blood pressure, and other indicators of dehydration in those situations. If you would like to learn more about severe dehydration, you can read “Hospitalized for dehydration.”
In conclusion, low albumin symptoms can be related to a low blood volume and increased swelling. People with malnutrition, poor nutrition absorption, excessive protein in the urine, and problems with the liver are at a high risk of getting low albumin symptoms. Low albumin can complicate the treatment of other conditions in hospitalized patients.
References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4956071/