Physiologic hypoalbuminemia is well tolerated by severely burned children

Background: Physiologic hypoalbuminemia, defined as a plasma albumin (pI-ALE) of 1.0 to 2.5 g/dL, is a component of the injury response, A consensus on the need for albumin supplementation in this setting is lacking. Methods: We examined 27 consecutive children (age, 7 +/- 6 years) with >40% body surface burns (mean, 59 +/- 18%) during their initial 4 weeks of care, Patients were managed with an albumin-supplementation protocol that tolerated profound physiologic hypoalbuminemia, Intravenous albumin was administered by infusion of 1 to 2 g/kg/d when pI-ALE fell below 1.0 g/dL, or below 1.5 g/dL in the presence of enteral feeding intolerance or pulmonary dysfunction, Supplementation was stopped when pI-ALE reached 2.0 g/dL. Results: Mean pI-ALE was 1.7 g/dL overall, Infusion for pI-ALE < 1.0 g/dL was needed for 70% (n = 19) of the patients, Profound physiologic hypoalbuminemia was constant, that is, mean weekly pI-ALE never exceed 2.5 g/dL in any patient, Mean plasma globulin rose during the 4 week period from 2.3 +/- 0.1 at week 1 to 3.1 +/- 0.1 at week 4, Diarrhea was negligible (19 of 756 patient days), nasogastric feedings were well tolerated, Pao(2)/Fio(2) ratios remained well above 150, wounds healed satisfactorily, and all children survived and have been discharged home. Conclusions: Profound physiologic hypoalbuminemia (pI-ALB of 1.0-2.5 g/dL) does not have adverse effects on pulmonary or gut function, wound healing, or outcome in severely burned children, perhaps because of a compensatory increase in acute-phase proteins reflected in plasma globulin.