Albumin Replacement Therapy to Treat Protein Losing Enteropathy (PLE)

What is Albumin?

Albumin: The main protein in human blood and the key to the regulation of the osmotic pressure of blood. Chemically, albumin is soluble in water, precipitated by acid, and coagulated by heat.

(Note: albumin is spelled with an "i" while "albumen" with an "e" is the white of an egg, the part of the egg from which meringues are made. "Albus" in Latin is white.)

**MY EXPERIENCE***

The spilling (Loss) of albumin that I experience is severe. In fact, it was suggested by my doctor that infusing albumin in me would be a waste of time.

My serum albumin measured <1 while my total serum protein was 1.9. Over a period of 7 years, I’ve been given albumin at differing doses, intervals and speeds.

Most recently, I was given 50mg albumin infused over 1 hour. Then 30 minutes later I was given 60ml lasix IV (push). This was repeated every 8 hrs for 5 days.

The net effect of this was a decrease in edema. My weight dropped from 165 to 133 lbs.in that same time interval.

Side effects of albumin that I noticed was a dull, uncomfortable headache.

Albumin (Human) 25% USP

Indications:

Emergency treatment of hypovolemic shock, burn therapy, cardiopulmonary bypass

Hypoproteinemia with or without edema, adult respiratory distress syndrome (ARDS)

Acute liver failure, neonatal hemolytic disease

Erythrocyte resuspension, sequestration of protein rich foods

Acute neophrosis

Contraindications:

Chronic nephrosis

History of CHF, renal insufficiency, or stabilized chronic anemia

Precautions:

Pregnancy category C

Monitor against signs of circulatory overload. Albumin 25% is hyperoncotic, therefore, in the presence of dehydration, albumin must be followed by addition of fluids.

In presence of hemorrhage, albumin should be supplemented by the transfusion of whole blood to treat the relative anemia associated with hemodilution. When circulating blood volume has been reduced, hemodilution following the administration of albumin persists for many hours. In patients with normal blood volume, hemodilution lasts for a much shorter time.

The rapid rise in blood pressure may follow the administration of a colloid with positive oncotic activity necessitates careful observation to detect and treat severed blood vessels which may not have bled at the lower blood pressure.

Adverse Reactions (Side Effects):

Rare: Such reactions may be allergic in nature or due to high plasma protein levels from excessive albumin administration. Allergic manifestations include urticaria, chills, fever, and changes in pulse, respiration and blood pressure.

Dosage:

Always administered by intravenous infusion; albumin 25% may be administered undiluted or diluted in 0.9% Sodium Chloride or 5% Dextrose in Water.

Hypovolemic shock:
The volume administered and the speed of infusion should be adapted to the response of the patient

Burns:
After a burn injury (usually 24 hours) there is a close correlation between the amount of albumin infused and the resultant increase in plasma colloid osmotic pressure. The aim should be to maintain the plasma albumin concentration in the region of 2.5 , plus or minus 0.5g, per 100ml with a plasma oncotic pressure of 22 mm Hg. This is best achieved by IV administration of albumin 25%. The duration of therapy is decided by the loss of protein from the burned areas and in the urine, In addition, oral or parenteral feeding with amino acids should be initiated, as the long-term administration of albumin should not be considered as a source of nutrition.

Hypoproteinemia with or without edema:
Unless the underlying pathology for hypoproteinemia can be corrected, the IV administration of albumin 25% must be considered purely symptomatic or supportive. The usual daily dose of albumin for adults is 50 to 75g and for children 25g. Patients with severe hypoproteinemia who continue to lose albumin may require larger quantities. Since hypoproteinemic patients usually have normal blood volumes, the rate of administration should not exceed 2 ml/min as more rapid injection may precipitate circulatory embarrassment and pulmonary edema.

Store at room temperature not exceeding 30 degrees C (86 degrees F).

Observations - Severe Edema & Albumin Replacement Effectiveness

Update - I went back to the hospital this past week.  I went in on Tuesday August 30, and came home Friday 3 days later.  I went in  with a wet weight of 189 pounds and left weighting a dry weight of 178 pounds.

My albumin level was 1.7     and my total serum protein was 3.2.  


These levels are pretty good for me, and I suspected they would be according to where my edema was most pronounced.


Edema characteristics are different depending on what the Albumin level is.  For example, when my albumin level is less than one, the edema uncomfortably manifestos  on the dorsal (top) surfaces of my feet; painfully stretching the skin almost bubble-like.  This  situation is in addition to severe generalized edema known as Anasarca.  


When the albumin level is less than 1,  the edema commonly  manifested in my scrotum, penis, as well as beneath  my chin.  


These areas are all known as ‘dependant surfaces’ because they are areas that water (edema) will dam up or collect simply because it can go no farther.  Even my belly at the belt line (my abdominal tissue) would collect fluid and hang outward  looking alot like a water bag!

In addition to severe edema affecting dependant areas, the edema at the less-than- one-level seems to manifest in my intestinal walls as well.


Furthermore, it has been my experience that I eat smaller meal portions  when the level is less than one because there is not as much room in my abdominal cavity for my enflamed intestines, my diaphragm and large portions of food.  I would feel full quickly, and would have difficulty breathing deeply (not enough room for diaphragm motion).


Prior to the severity of my edema progressing to this degree, I’ve noticed that my oral Lasix gradually lose their effectiveness.  As they do, my edema gradually increases culminating into the severe symptoms described above.


Treatment I receive for this is simple:  Albumin (human) 25%, USP  In a Single Use 50MIL vial (every 8 hours), and 60 to 80ml Lasix 30 minutes following each Albumin infusion.

Blood pressure monitoring as well as electrolyte level monitoring are a must.


I have made some observations concerning this albumin replacement therapy.  


First observation when my albumin level is so low, it takes about 36 hours before I really start urinating a lot and see a significant weight (edema) loss.  Also, salty snacks can hamper this therapy’s diuresis effects.

Another observation of mine is that body movement helps the process of diuresis. (Diuresis is the medical term for eliminating edema via urination through the use of pharmaceuticals.  Diuretics pull fluid into the bladder to be eliminated).  


I have found that taking regular walks seems to help the diuresis process.  I believe that this is due to the increasing circulatory activity.


A third observation pertains to how the edema decreases.  The first place I notice it decrease is my intestines.  Very quickly I begin to feel less bloated.  Next, my arms, then my lower legs lose their edema.  After that, I lose it in my dependant areas last.

One thing to know is that you have to use your weight to accurately assess fluid loss.  This is because you can be fooled when in bed (supine) for a number of days, your edema will have a new dependant surface:  your back.


If your back is your dependant surface, your shins (lower extremities) will be skinny though you’re edema hasn’t actually decreased.  So, use your weight.


When being weighed by hospital staff, you should ensure the scale is accurate.  If your weight when checking into the hospital  wildly differs from what you know your weight should be, you should confirm the weight by weighing on another scale.  


After you are confident the weight is accurate, you should use the same scale for every daily weight.  Additionally, you should be weighed at roughly the same time each day. 


Also, refer to your weights in terms of dry or wet weights.  I have gone in the hospital with a wet weight of 200 pounds, and  7 days later  discharged with a dry weight of  170 pounds.




Well, I’m going to leave it here.  I hope this information is useful to you in some way.

Update - Spironolactone may be Helping to Retain Albumin

I traveled to the hospital with the expectation of being admitted for another round of Albumin infusions and Lasix via IV push.


Upon getting my blood work back from the lab, my primary care doctor and I happily discovered that my Albumin level was 2.1.


Why is this a good number?


I left the hospital after a 4 day stay September 2nd. and my Albumin was 2.7.  That is only .6 higher than it is now and I have been out of the hospital, (away from 3 infusions of Albumin a day) for at least 40 days.

When I went into the hospital, that stay, my Albumin was 1.7.

So, at least for now, my Albumin seems to be trending upward.

My Rheumatologist  believes the reason for this may be the Spironolactone I began taking several months ago.

I just looked up this drug and see where some folks claim it helps with fluid retention for folks with congestive heart failure.  I DON'T HAVE CONGESTIVE HEART FAILURE but   It may be  helping with my fluid retention problems because somehow it is helping my body  retain my protein (which, when low, causes  a change in osmotic pressure allowing fluid from the cells to move across the cell membranes and  'third-space').

Since my Albumin showed this 2.1 measurement, we decided I didn't need to be admitted for agressive diuresis.  We decided that I'd increase my spironolactone  as well as my daily lasix.

Plasma Protein, Albumin Information

Living with this disorder has been a real struggle. As you may already know, protein in the body is important for a number of functions.

According to Wikipedia, human serum albumin is the most abundant protein in human blood plasma, and it is produced in the liver. Albumin comprises about half of the blood serum protein. It is soluble and monomeric.

Functions of albumin

1. Maintains oncotic pressure - I’ve had severe edema. The absence albumin leaves little for water, in cells, to bind with. So water flows across the cell membranes third spacing.

2. Transports thyroid hormones

3. Transports other hormones, particularly ones that are fat soluble

4. Transports fatty acids ("free" fatty acids) to the liver - I guess this is why my triglycerides and cholesterol are always sky-high. If fatty acids don’t get transported back to the liver, the liver acts like there is not enough in the blood and makes more.

5. Transports unconjugated bilirubin

6. Transports many drugs; serum albumin levels can affect the half-life of drugs – With this I’ve noted that when I have a high edema level (anasarca) my lasix (diruretic) doesn’t seem to make me urinate as much. Sometimes it stops working altogether.

7. Competitively binds calcium ions (Ca2+)

8. Buffers pH

9. Serum albumin, as a negative acute-phase protein, is down-regulated in inflammatory states. As such, it is not a valid marker of nutritional status; rather, it is a marker in inflammatory states - In my case, My ESR (erythrocyte sedimentation rate) an indication of inflammation in the body was VERY high.

Which of these functions have you noted issues with in your own life? Leave a comment and tell us about them.

Albumin and Lasix Dosage for Treating Hypoalbuminemia Symptoms Associated with PLE

~DANIEL TAVERNE~

I spent a week in the hospital recently. I came back tuesday, the 7th day of my admission. Each time I go for hypoalbuminemia I get this treatment. Sometimes it's twice a month... sometimes it's only once per month.

First of all, I'm a 43y/o male...my base weight is about 160lbs.

They gave me 50ml of Albumin - infused over an hours time q8hrs...every 8 hours. Each was followed by Lasix IV push...dosage below. My blood pressure was monitered every 4 hours and my I/O was recouded. I'll get this treatment daily untill I reach my base weight.

I was treated for the hypoproteinemia that I spill into my GI tract somehow. The exact cause of this spillage, or what ever is causing my albumin to be low is still unclear after 8 years. My Albumin has been less than 1 for a long, long time.

I get anasarca (generalized edema-fluid retention all over my body. This fluid is very incomfortable - sometimes painful- and I get tired...lacking energy to do many thing I like to do in life.

Well, while in the hospital the dose given was 50ml of albumin (intravenously) 3 times a day, or every 8 hours. Each one of those doses was followed up with 60ml of lasix (IV push)
Occasionally my albumin level seems to spontaneously increase. And, occasionally that happens when I'm in the hospital. I've lost as much as 40 pounds of fluid... that's alot of peeing!

For some reason, though I went into the hospital last seek, my protein has been slow to fall. This has allowed me to be more enthusiastic about life. I began lifting weights again and boy am I getting pumped up.
I'm not sure what my albumin lever is now, but it still isn't so bad. I think it'll gradually decrease though as it always seems too.

Results of Latest Albumin Replacement Therapy

As indicated in my last blog entry, I did go to the hospital seeking treatment for severe anasarca (generalized edema over most of my body) due to my albumin being very low.

Since I have a great relationship with my doctor, she notified the VA hospital's red medicine service that I needed to come in.

Fortunately, hey arranged a direct admission.

I arrived at the emergency room at about 7:30pm last tuesday, March 6, but I didn't get my room until around 2:00am.

I received  my first infusions wednesday morning at around 5:00am.

As noted in my previous post, I recieved 3 albumin infusions every 24 hours; each followed by an IV push of Lasix. 

When I was admitted into the hospital, my serum protein was 1.9 and my albumin was .9. 

My weight  upon admission was 195 lbs.

When I was discharged monday morning March 12, my weight was 172 lbs!

In 5 days, I lost about 23 pounds of edemic fluid!

As you might guess, I felt a whole lot better.  I can't tell you just how good I felt to be thinner again.

I wish I could stay this way, but I know its only a matter of time till I start packing on the fluid again.
If you want to know the dosage of the Albumin and Lasix I was taking, you can find that information on this blog. 

Give it a look.  If you have any questions, use the guestbook or leave a comment.

5 Things to Know about Your Medications to Avoid In-hospital Errors

As a professional patient,I speak from the pulpit of experience when I say make learning about your medications a priority.

Insist that you and the doctor are clear on exactly what medications you’ll be given. Furthermore, you should be familiar with what your medication’s general purposes are, as well as the dangers associated with their improper administration.

Why do I make these recommendations? Because people (including medical professionals) make mistakes. The following story illustrates this fact.

While a patient at G.V. (Sonny) Montgomery VAMC this past weekend, I avoided a hazardous situation because I asked my nurse what pills she was giving me.

I knew from speaking with my doctor that I was prescribed Lasix at 60mg, 4 times a day intravenously. This is all the Lasix (Furosemide) I was to be given while in the hospital. However, among other pills, the nurse was handing me the same Lasix dosage in pill form. Now add that up and it’s 480 mg/day.

Lasix is a potassium losing diuretic that can cause people’s potassium level to drop which could cause a serious (even fatal) cardiac incident.

I refused the extra doses because I was aware of:

1. What medications I was taking
2. How much I was supposed to take
3. How It was to be administered
4. Why it is given
5. What could happen if I took too much

You have to be your own advocate. You have to be aware there are nurses out there who don’t think for themselves. That said, they seem to be drones who don’t pay attention to anything except how to do the least amount of work, and how long till quitting time.

Unfortunately, some nurses have a bad attitude. They think they‘re above the patient‘s reproach, because patients don’t know anything. The following story illustrates this nicely. It also happened during my latest hospitalization.

Many of my nurses always administer my Albumin piggy-backed with saline flush bag. They do this because they think it is easier to prime the tubing with saline(Albumin is really thick), and so the tubing flushes clean automatically with saline after the albumin empties.

The problem is, many times when they do this, I get all saline, and none of the Albumin. Saline (fluid) is THE LAST THING I need when I’m going for diuresis (fluid reduction)

I tried avoiding this error by suggesting we clamp off the saline tubing like other nurses do. To make a short story shorter, she said, “If patient’s know so much, what am I here for.” with quite a note of sarcasm.

I know getting the saline pumped into me wasn’t dangerous, so I didn’t push the issue and allowed her to do it the way she wanted.

Guess what happened? 30 minutes later the Albumin was still in the bottle on the IV pole. I called that nurse back to my room and let her know I was not one of those patients who doesn’t know what’s going on.

My point is, if you are able, you should involve yourself in your care. Don’t passively assume your nursing staff will make no errors. Simply knowing what, how, why, when and how much will go a long way toward reducing the risk of inpatient medication errors.

If you’d like to discuss this further, or have a related story to tell, use the comment link below this post. I’ll make it a point to post your thoughts on this site. Thanks.

Observations Related to Prolonged Protein Increase

(Picture - a reminder: When flash flooding is occuring, turn around, don't drown)

Keep in mind here that my weight without edema is approx 127lbs. When I was healty however, my weight was in the 170's... that was back in about 2002.

For one reason or another, I've had moments (peoiods of time lasting weeks) when my protein would "spike". That is, my protein would suddenly albeit, enigmatically rise to near normal.

My doctor had discussed possible causes of the spikes, and had even tested some of your theories.

One such theory is the reason for this post. You see, my doctor, Suzanne Sanders of G.V. Sonny Montgomery Veterans Medical Center in Jackson, MS had suspected that some antibiotics were responsible for my protein spikes. When we tested this hypothesis with the administration of IV antibiotics while hospitalized, our hypothesis was not supported.

This past month I was admitted to the hospital with anasarca. My weight was 165lbs. I had pitting edema all the way up to my cranium.
I went in the hospital Jan 22, and came out Jan 27. I went from the weight of 165 pounds to 135 pounds. I was treated with albumin infusions as well as lasix IV push. I was getting 50mg Albumin infused over 1 hour q8 hours. Each albumin infusion was followed up with an IV push of 60 ml of lasix given 1/2 hour after each albumin. We chose this aggressive strategy of direusis since my last hospitalization yeilded little results with the albuming and only 40ml lasix given q 12 hrs.

Okay, back to the antibiotic angle: While in the hospital, the doctors found my white blood cell sount rose to 17. After investigating they determined it was probably an absessed tooth causing it so they prescribed an oral antibiotic, clendamyacin (sorry if I spelled it wrong).

I had 2 weeks worth of it. Today is Feb 9, and I'm still in the 130 pound range.

My oral lasix is still working very well. Usually, by now my weight would be creeping back up as my lasix slowly diminishes in effectiveness.

The reason I'm talking about my weight a lot is because that's how I (roughly) guage what my protein level is without a blood test. When my albumin is less than 1, and my total protein is 2 or less my edema (and my weight) increases dramatically.

Hence, when my weight stays low for an extended period of time, I can pretty well be sure my protein is in a more acceptable range. Anyway, I ran out of the clendamyacin yesterday. I have a prescription for another antibiotic i'm going to be taking till it is gone, then we'll see what my protein level does.

***25 Feb 2010:  147.6 pounds at 10:00 pm  I ate several pickles today.  I'm adding this at 1:30 am Friday morning.  I seem to have been urinating a lot tonight.  I think that's a good thing.  I don't want to retain that water (third spaced) it really sucks.

Nursing Styles say Much about the Person

The style-labels I use below describe how nurses relate and interact with patients while performing their duties.

Fast and efficient:  These nurses usually appear strangely calm while moving 100 miles per hour.  They seldom speak, but  when they do, their words are short and direct.

These nurses zip in, do what they have to do, then zip out.

I liked this style best in the middle of the night when trying to sleep.

Warm Helpful & Caring:  I’ve had lots of experience with this style of nurse.  One such nurse, Gaylord, is a sweet woman.  If I show up on the ward after a lengthy absence, she greets me with a giant hug. 

One afternoon she had to give me an intramuscular Octreotide hip injection.  Octreotide is very thick so the needle was quite large. 
I must say, when Gaylord started crying because she had to give me that shot, I realized just how caring she is.

Knowledgeable and compassionate:  These nurses exude confidence and control. On many occasions, nurses fit this category might make remarks about how a nurse on the previous shift messed something up.

This nursing personality  believes the needs (comfort, safety & Medical) are their top priority.

Another nurse, Lorraine, fit’s the this style. 

In 2009, I was hospitalized with very painful necrotic toes.  It didn’t take long for me to discover that morphine didn’t work for me.
I needed something stronger, but because the doctor suspected I was a “pain-seeker”, she wouldn’t do anything else for me.

Then I had to have my toes amputated.  As you might guess, it was very painful.  This time, Lorraine advocated for me, insisting to the doctor that I was, in fact, in pain and the morphine wasn‘t helping.

Lorraine’s advocacy for me ensured my pain was properly treated. That said, Lorraine’s knowledge and compassion continue to give me great confidence in her abilities.

Lost, lazy,  incompetent  Some nurses make me nervous as can be.  They stomp into the room, and struggle to get things right. 

For example, some  nurses have a difficult time setting up IV pumps.  Some don’t know, for example, that most albumin bottles have ‘vent caps’ in their necks.  Removing this cap allows air to flow into the bottle so the albumin can flow out. 

I had one nurse stabbing the albumin bottle’s ‘spike-port’ with syringes; injecting air into the bottle.  This eventually works, but the albumin bottle looked like a pin cushion and albumin dripped all over the top of the IV pump.

Some of these nurses don’t like answering nurse call buttons and act like they are doing me a favor when  I ask for something like water, for example.

Occasionally, these nurses don‘t want to hear it when the patient trys to explain how something should be done.

The example of this is when I began explaining to nurses about opening the vent cap and they don‘t do it.  After they leave the room I get out of bed and open it myself.

Obviously, this list of nurse types is not all inclusive.  The idea I wanted to get across here is that the way each nurse cares for patients is a direct reflection the nurse’s personality.

What are your thoughts? Do you have any memorable tales about one or more nurses?  If so, leave it in a comment.

Update: A couple weeks after my last hospitalization

You can see from the post below this one that I went to the hospital a few weeks ago to get the Albumin replacement.


Since my albumin was less than 1, I stayed for several days getting transfusions.  I also received IV Lasix immediately following each albumin dose.


My current weight is 173.2 pounds.  This is very good since my weight has not increased since I've been home.


This means that my edema has not been increasing.


I have noticed some fluctuation in my energy level, and at times seem to feel bloated.


Upon getting exercise (cutting the grass with a push mower) Sunday,  I have felt energized.


I have been able to do a lot of stuff today (Monday).


Do you think you need albumin replacement?  Tell me about your symptoms.  If you need a sympathetic ear to talk to, sign my guestbook or leave a comment and spill your guts.


Take care.  Remember, God loves you and you will be blessed if you follow Him.

Effects of Low Protein on Hair Growth

      These are not my legs

I have experienced hair growth changes that vary with my protein levels.


When my Albumin is less than 1, for instance, I seem to lose the hair on my legs, and my facial hair as well as the hair on the top of my head seems to grow slower.


When my Albumin increases to 1.7 or more, I begin to notice stubble on my legs.


I have never been an excessively hairy fellow, but prior to my hypoalbuminemia medical condition I did have hairy legs. I’m a guy, and I don’t shave them, but for the longest time, my legs have been bald.


Now that my Albumin level is above 1.5, I’m noticing lower leg hair growth and I kind of like seeing it.


I started taking a drug called Spironolactone last spring, and since, my albumin has seemed to remain above 1.5.

Is there a Cure for Hypoalbuminemia?

Is there a cure for Hypoalbuminemia?

Well, depending on what the cause of your case is, there just might be. 

Some albumin loss can be contributed to conditions that can be addressed.

Heart defects, Celiac disease, vasculitis and other conditions can be addressed through surgery, diet or medications.

  However, other conditions may not be curable, in which case treatment of symptoms might be the doctor’s only recourse.  I have an idiopathic form of the condition.  This means the cause of my low albumin is unknown. 

While the doctors haven’t yet given up on finding a specific cause to address for me, they have been focusing on the treatment my symptoms.

Diuretics, Albumin infusions, infection control, dietary and other strategies have been brought to bear.

Also, I’ve tried a number of drugs, both injections and oral, to try to address the low protein issue itself.  I’ve had moderate success with Humera, but had to discontinue it due to a Tuberculosis side effect.  I’ve had some success with Prednisone but had to stop due to Vision and other uncomfortable side effects.

I tried a chemotherapy drug called Cytoxan, an IV drug.  That was rough on me.  It seemed to help a little too.  That’s not a drug to be on indefinitely.

Well, this is all for now.

  

Indications of Higher Protein Levels - Update

As noted in earlier posts, my weight is a good indicator of my protein level. If my albumin is low, my weight increases over time due to edema.


Inversely, when my albumin is higher, my weight (edema) decreases..


I believe my weight is dropping significantly right now, so my protein must be up. 22 days ago I weighed 199 pounds. Yesterday, I weighed 176.


Also, since I’ve been ill, I notice I have no hair on my legs after a long period of time with low protein. Then, as my weight begins to decrease due to an increase of protein, hair begins growing on my legs again.


Another more personal way I can tell my protein level may be on the rise is sexual arousal. I’ve noticed this aroused state more frequently lately.


Medication changes: I was taking Budesonide 1 cap every day. I decreased this to every other day.


Diet change: Over the past week, I’ve increased my fish intake significantly.


Dec 6-11 I was in the hospital getting albumin infusions and Lasix tid (three times a day) q8


The week I came home, I changed that budesonide dose. That week, my weight started creeping back up.


Then, I broke my leg on Dec-19. It seemed that immediately following that event, I began feeling less edemic.

My PLE Hard times

Let me tell you, I know first hand how low serum protein can effect a person. You see, protein plays an important role in fluid equilibrium. Think of protein as little grains of sand that soak up water. Protein doesn’t really soak up water, but through atom polarity on a molecular level, protein holds H2O close to it (within the cells). When a large percentage of a person’s protein molecules are missing, it upsets normal osmotic pressure of the cells, and water simply runs into the tissues between the cells. This is often called, “Third Spacing”.

I’ve had as much as 60 pounds of fluid (water) third spaced at a time. Let me tell you it really sucks!

How I dealt with it? Well, I had a tough time.

I was unhappy with looking like a little fat guy. I had a hard time cleaning my self, and at one point the skin on my legs was stretched to the point of causing much pain. I had a hard time walking and could hardly bend my knees. I could barely pull my pants up from the floor, and I often had to lay with my feet and legs propped up in the air even during “fun” family events like Easter, the fourth of july and so on.

How I copped? I took it one day at a time. I cut down, way down on my salt intake. This didn’t help me as much as my doctors felt it should have.

I put my shoes on in the morning because this is when I found my fluid there to be at its lowest.

I used lotion on my legs to help allow my skin to strech.

I complained… that is, I vented my frustrations to my wife which helped me face my emotions about my condition. I didn’t want to go anywhere because I looked so bad.

I tried Beneprotein soy powder as a protein supplement. This helped my loose stools, but did little for my edema.

My doctor agreed I was in a bad way and began me on intravenous Immunoglobuluns (ivig), IV albumin, and Iv lasix. This helped some. It helped boost my immune system, helped get some of the fluid off me, and raised my albumin level if only very briefly. I was placed on a drug called Methotrexate. I was prescribed a subcutaneous injection every week at .4 mg. After the 2nd week, my doctor said to give myself an additional .4 mg which I did. That was on a Friday. By Monday, I was caughing and hacking because I suddenly developed a pneumonia like condition called methotrexate lung. The lungs fill with some weird nodules, and got really sick.

The funny thing is, about 3 weeks after that first methotrexate injection, my protein levels shot up to just about normal. This lasted for about 3 weeks and I gradually began packing on the edema again as my protein levels started falling.

I subsequently took it upon myself to try a single dose one desperate afternoon just to see what would happen. 3 weeks later my protein again shot up. But I began to develop infection like symptoms in my chest so I told my doctor what I did. Let me tell you by the time she got done with me I was promising not to do that again.

I didn’t end up with methotrexate lung again, but I did have me a scare.

Then I went to the mayo clinic. Iwas eventually diagnosed with Menetrier’s disease and was advised to try octreotide. My doctor prescribed it eventually, and a few weeks after my protein began to rise. Albumin went from less than 1 to 2.0.

My total protein went from 1.9 to 4.8.

These numbers may sound like small changes, but believe me they make a world of difference in the edema department.

The skin on my legs was so tight at one time that a shard of glass falling from counter level cut my leg with a very light glancing contact. My leg then dripped water for over a month. Every pair of pants I put on soon had a soaked leg from the shin down..

Well, this is good for now. Any questions or any stories of your own, leave them in the comments please.

Thanks,

Daniel

Lasix and Hypoproteinemia - low protein

This is from a patient's perspective.

I am an educated allied health science disabled patient... let me explain why I have to take lasix due to my low protein:

The protein I'm low in is Albumin.  This is a plasma protein that helps hold water/fluid inside blood cells and other cells.  Without the Albumin holding water 'in',  the water runs out into the interstitial tissues... This is what they call third-spacing.

Doctors describe this process in terms of "osmotic pressure".  That is the osmotic pressure is upset, and fluid is allowed to run across semipermeable cell membranes, causing edema (fluid accumulation in body tissues).

This is where Lasix comes in.  The Generic name is furosemide.  This medication pulls fluid into the bloodstream and is allowed to be eliminated upon urination.  Exactly how this works is not clear to me.  All I know is, it's supposed to make you pee.

Now, the reason I'm losing my protein is yet unclear.  The results of the protein loss in me is generalized edema and (I believe) this edema also builds up in my intestines.

I believe this because on many occasions, medications taken by mouth including  lasix seem to lose effectiveness.  When this happens, I accumulate exessive fluid - upwards of 40 pounds.. that's almost like pouring 5 gallons of water inside my skin.

Before it gets to this point, I call my doctor who has me admitted into the VA hospital where I am treated.  I explain the treatment in previous blog entries.

The treatment involves IV meds including Albumin as well as Lasix which then doesn't have to be absorbed across the intestinal walls... it works then let me tell you.

I get 60 to 80mg of lasix either 2 or 3 times per day, causing me to urinate up to 2 liters or more for each dose.

I've noticed my first urinations are typical yellow in color, but the second liter is very clear and the color of tap water.

hypoproteinemia - hypoalbuminemia - low protein - treatment - medications - patient - case history - case study

Emergency Treatment for my Hypoalbuminemia

Will there ever be a need for me to have  “emergency” treatment for my hypoalbuminemia?


My kneejerk reaction was to answer "no", but thinking back now, I remember instances when my breathing was impaired due to acites (fluid accumulation in the abdominal area), so I have to answer my question with a "yes". This fluid was interfering with my mechanical ablility to inhale deeply enough to maintain a normal oxygen level.


I have also had fluid accumulate around the lining of my lungs (plural effusion) which would impede the full inflation of my lungs.


In my case, the fluid overload I was experiencing was treated with a combination of Albumin infusions, and intravenous Lasix. That said, the plural effusions were taken care of manually by physically draining them with a needle.


I can’t say that because of my low albumin that I was in danger of death because of these two issues, but I was extremely uncomfortable, and in some pain.


Another emergency, not necessarily due to the fluid overload, are serious infections. When these unfortunately arise, I’m usually given strong intravenous antibiotics as well as intravenous immunoglobulins to help boost my immunity.


Many of my hospitalizations I was given the albumin and lasix at 8 hour intervals for a week, then before I left, they were followed by a final dose of the immunoglobulins.


This final dose sometimes seems to help the other proteins gain a foothold in my circulatory system as evidenced by unusual spikes in my total protein level.


Questions, comments or criticisms can be left either in a comment or in my guestbook.

Life with Protein Losing Enteropathy (PLE)

Let me tell you, I know first hand how low serum protein can effect a person. You see, protein plays an important role in fluid equilibrium. Think of protein as little grains of sand that soak up water. Protein doesn’t really soak up water, but through atom polarity on a molecular level, protein holds H2O close to it (within the cells). When a large percentage of a person’s protein molecules are missing, it upsets normal osmotic pressure of the cells, and water simply runs into the tissues between the cells. This is often called, “Third Spacing”.

I’ve had as much as 60 pounds of fluid (water) third spaced at a time. Let me tell you it really sucks!

How I dealt with it? Well, I had a tough time. I was unhappy with looking like a little fat guy. I had a hard time cleaning my self, and at one point the skin on my legs was stretched to the point of causing much pain. I had a hard time walking and could hardly bend my knees. I could barely pull my pants up from the floor, and I often had to lay with my feet and legs propped up in the air even during “fun” family events like Easter, the fourth of july and so on.

How I copped? I took it one day at a time. I cut down, way down on my salt intake. This didn’t help me as much as my doctors felt it should have.

I put my shoes on in the morning because this is when I found my fluid there to be at its lowest.
I used lotion on my legs to help allow my skin to strech.

I complained… that is, I vented my frustrations to my wife which helped me face my emotions about my condition. I didn’t want to go anywhere because I looked so bad.
I tried Beneprotein soy powder as a protein supplement. This helped my loose stools, but did little for my edema.

My doctor agreed I was in a bad way and began me on intravenous Immunoglobuluns (ivig), IV albumin, and Iv lasix. This helped some. It helped boost my immune system, helped get some of the fluid off me, and raised my albumin level if only very briefly. I was placed on a drug called Methotrexate. I was prescribed a subcutaneous injection every week at .4 mg. After the 2nd week, my doctor said to give myself an additional .4 mg which I did. That was on a Friday. By Monday, I was caughing and hacking because I suddenly developed a pneumonia like condition called methotrexate lung. The lungs fill with some weird nodules, and got really sick.

The funny thing is, about 3 weeks after that first methotrexate injection, my protein levels shot up to just about normal. This lasted for about 3 weeks and I gradually began packing on the edema again as my protein levels started falling.

I subsequently took it upon myself to try a single dose one desperate afternoon just to see what would happen. 3 weeks later my protein again shot up. But I began to develop infection like symptoms in my chest so I told my doctor what I did. Let me tell you by the time she got done with me I was promising not to do that again.

I didn’t end up with methotrexate lung again, but I did have me a scare.
Then I went to the mayo clinic. Iwas eventually diagnosed with Menetrier’s disease and was advised to try octreotide. My doctor prescribed it eventually, and a few weeks after my protein began to rise. Albumin went from less than 1 to 2.0.

My total protein went from 1.9 to 4.8.

These numbers may sound like small changes, but believe me they make a world of difference in the edema department.

The skin on my legs was so tight at one time that a shard of glass falling from counter level cut my leg with a very light glancing contact. My leg then dripped water for over a month. Every pair of pants I put on soon had a soaked leg from the shin down..

Well, this is good for now. Any questions or any stories of your own, leave them in the comments please.

Is the Albumin Infusion Safety Question put to Rest for Chronically ill?

In the following video, the speakers refer to the use of Albumin infusions as related to ICU patient recovery... using Albumin in place of normal saline.


I'm curious about the longterm effects as a treatment for chronic hypoalbuminemia.


Forwarding myself as a study subject, so far, I have not noticed any adverse side effects. Here is the video mentioned:

What is Hypoproteinemia?

Hypoproteinemia, simply put is low blood protein levels.  There are 2 main protein types: Albumin and globulin.  Abnormal blood test results  related to these are usually delineated with a corresponding 'hyper' or 'hypo' (high and low- respectively). 

For example, Low Albumin (a plasma protein) is called, Hypoalbumemia.  This condition can also be loosely referred to as hypoproteinemia. 

"Normal" Total serum Protein level (in humans) should be between  6.0 and 8.3 gm/dl (grams per deciliter).
Normal albumin level is from 3.4 - 5.4 grams per deciliter (g/dL).

The difficulties arising when these numbers depart from normal are quite astonishing.  That said there are many conditions that can cause departures.

Higher-than-normal levels may be due to:

**ChronicChronic inflammation or infection, including HIV and hepatitis B or C
**Multiple myelomaMultiple myeloma
**Waldenstrom's diseaseWaldenstrom's disease

Lower-than-normal levels may be due to:
**AgammaglobulinemiaAgammaglobulinemia
**Bleeding (hemorrhage)
**BurnsBurns (extensive)
**GlomerulonephritisGlomerulonephritis
**Liver diseaseLiver disease
**MalabsorptionMalabsorption
**Malnutrition
**Nephrotic syndrome
**Protein-losing enteropathy

Back to Hospital: The Why and the How

I have a doctor appointment with Rheumatology tomorrow at Sonny Montgomery VA Medical Center in Jackson, MS.


My edema is excessive, as noted in a recent post, so I’m going to try to be admitted for diuresis. This means I’ll be given infusions of Albumin and Lasix at regular intervals (every 8 hours). For dosing information, use the search box, or use the links posted in the column on the right to manually read for the information.


You can use the search box above to search “Albumin and Lasix to treat Hypoalbuminemia”.


Usually when I get this treatment, I stay for approximately 5 days and I decrease my weight by about 20 pounds.


The fluid accumulation in my left leg is much more pronounced this time than any other. I have had unequal distribution of lower extremity edema before, but not to this extent. Therefore, I have to conclude that my broken leg is somehow contributing to this inequality.


Even the top of my left foot is puffed up… almost like a little-flat-water balloon.


When I go tomorrow, I’ll pack an extended stay bag with the essentials… Razor, toothbrush, underwear, socks, some Pjs and some cloths to wear on the day I come back home.


I ride the greyhound bus back and forth. This costs about $70 each time I go to the hospital. This travel expense has forced me to limit the trips, which puts off some important appointments.


What I invariably end up doing is postponing appointments till I can arrange them all around one day’s time, or I wait till I need to be hospitalized, then I go.


And the price of fuel is always going up, so I imagine bus tickets will be going up as well.