An elderly man was admitted to the unit with hypoproteinemia due to chronic maln

Question

An elderly man was admitted to the unit with hypoproteinemia due to chronic malnutrition. His medical history reveals the following: HTN, CHF. His medications are: Digoxin 0.125 mg qd; Lasix 40 mg qd; KCL 20 mEq qd; Lisinopril 10 mg qd.

Physical exam reveals a thin, cachexic male, who has edematous hands, and feet.

BP 98/50; HR 90; HT; 5'9"; Wt; 62 kg.

His lab reveals a total protein level of 4.8 g/dL, K+ of 3.8, Na 131, Hematocrit 30.

1. How is his protein level affecting his physical appearance?

2. What factors might his medications play in his malnutrition?

3. He is going to receive one unit of 5% albumin. How does it work in this situation? Why not just feed him?

4. What advantages does albumin have over using a crystalloid like lactated ringers in this situation?

5. What adverse effects should you monitor while he is receiving albumin?

Explanation / Answer

1) The main function of protein is body building.When there is a deficiency of protein ,there is failure of muscle growth.They are made of amino acids without this it is impossible to build, repair or even maintain muscle tissues.

Hence the patient will look lean , skinny and malnourished.

2) Medication plays a vital role in his malnutrition , because every medicine has it's own side effects,The medicine which he takes has special side effects on gastrointestinal system, which might lead to malnutrition

3) Just feeding this patient will not be a recovery because there is hypoproteinemia leading to decreased amino acids production.Hence administration of albumin will help the patient

4) It helps maintain intravascular colloid osmotic pressure , neutralize toxins and transport therapeutic agents.It helps fluid stau inside the vasculature than leaking into tissues and causing edema.Where a lactated ringer cannot do this which contains the electrolytes

5) The adverse effects to be monitored are

Vomiting

Flushing

Fever

Chills

Itching

Bradycardia

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