Can Anyone Shed Light On Hypovolemia And Albumin

[Lenna]

My son just had his calcium and parathyroid hormone (PTH) tested to see if he has hyperparathyroidism. His calcium was slightly high but his PTH was very low, which means it is unlikely that he has has a problem with his parathyroid. However, his doctor did mention that his albumin was high which is likely the reason his calcium is high. His doctor is going to do an ionized calcium test to be on the safe side.

My question is, why does he have a high albumin count? I googled high albumin and it seems to be caused by dehydration. The kid drinks 3 litres of water a day...how can he be dehydrated? But he is hypovolemic. Does this mean he's dehydrated? I'm really confused about this. Can anyone explain it to me?

Thanks.

Lenna

[mae]

From what I've read high Albumin can be from high blood pressure, heart disease, kidney damage or liver.

Is he drinking things other than water? You can become over hydrated which makes you dehydrated?

Mae

[ramakentesh]

Elevated albumin is unusual and it wouldnt be the first sign of liver damage as ALT, Billirubin and AGT are usually elevated before albumin. It COULD indicate low blood volume possibly.

[Lenna]

From everything I've read online, LOW albumin is a sign of disease but high albumin is not. Of course, I'll have a conversation with his doctor now that I've done some reading. But I just want to enter the conversation with as much knowledge as I can, and my questions all prepared.

Can anyone else offer anything?

Thanks so much!

Lenna

[Broken_Shell]

Hi,

How high is his albumin? Elevated albumin can occur in dehydration. Has his albumin been normal in the past? I have had slightly elevated albumin levels in the past and no one was ever very concerned about it. Like some of the previous posts said, low albumin is more of a red flag, depending on how elevated the level was.

Good luck. I hope that everything works out well for you and your son.

~ Broken_Shell

[firewatcher]

I had an argument with my Nephrologist on the difference between hypovolemia and dehydration. He was scared of me after that. This is from several different medical sources:

Hypovolemia versus Dehydration

* Hypovolemia

o Loss of extracellular fluid

o Absolute loss of fluid from the body

o Reduced circulating volume

* Dehydration

o Concentration disorder

o Insufficient water present in relation to sodium (what was his serum sodium level?)

Albumin is the most abundant serum protein. Albumin is produced exclusively in the liver and secreted directly into the circulation. Physiological roles includes maintenance of oncotic pressure (albumin provides 80% of the plasma oncotic pressure), and transport of small molecules such as calcium, unconjugated bilirubin, free fatty acids, cortisol and thyroxine. Albumin also binds drugs in the serum, eg warfarin, phenylbutazone and clofibrate.

Serum albumin is a useful marker of chronic liver disease and nutritional status, although consideration must be given to other factors contributing to the level.

High albumin concentrations in plasma:

Elevated concentrations of albumin in plasma are caused by a relative loss of water. This occurs in dehydration, or with prolonged use of a tourniquet. There are no pathological conditions other than dehydration associated with a high albumin concentration. Note however that elevated albumin may indicate artefactual elevation of other analytes such as haemoglobin, lipids and calcium.

All of this is further complicated by the plasma shift that normally occurs with orthostasis! It will depend on the position he was in for the 20 minutes before the blood was drawn: upright or supine. A plasma volume shift NORMALLY occurs out of the cells and into the bloodstream when you are laying down, but it takes a full 20 minutes to complete. As much as a 17% shift can occur in "normals" diluting the blood (sometimes giving false anemia indicators.) That same shift occurs OUT of the bloodstream when you are upright for 20 minutes or more. For those with POTS it has been demonstrated that this shift can be much greater (up to 25%) which is what leads to pooling and hypotension.

Why is he dehydrated if he's drinking that much? Is he urinating frequently? More than he is taking in? He may need to be evaluated for Diabetes Insipidus (where the brain does not make enough ADH or the kidney is unresponsive.) There is a drug (dDAVP) that is given as a surrogate for this hormone and it allows the kidney to concentrate the urine and hold on to that water. It works VERY well for me. I would ask to try dDAVP for volume expansion before I'd do IV therapy. PM me if you want more info.

[mae]

Because kidneys normally prevent large molecules such as albumin from being excreted in the urine, high levels of urinary albumin excretion?called albuminuria?can be an indicator of kidney damage. Albuminuria may also reflect dysfunction of endothelial cells throughout the body, which in turn may be a precursor to hypertension "October 2008 issue of the Journal of the American Society Nephrology (JASN)

Another sign of CKD is proteinuria, or protein in the urine. Healthy kidneys take wastes out of the blood but leave protein. Impaired kidneys may fail to separate a blood protein called albumin from the wastes. At first, only small amounts of albumin may leak into the urine, a condition known as microalbuminuria, a sign of failing kidney function. As kidney function worsens, the amount of albumin and other proteins in the urine increases, and the condition is called proteinuria. CKD is present when more than 30 milligrams of albumin per gram of creatinine is excreted in urine, with or without decreased eGFR. kidney.niddk.nih.gov/kudiseases/pubs/highblood/ -

Was his test urine or plasma?

[ramakentesh]

Actually i found an old blood test of mine where mine was slightly elevated as well. Interesting.

'Albuminuria may also reflect dysfunction of endothelial cells throughout the body, which in turn may be a precursor to hypertension "October 2008 issue of the Journal of the American Society Nephrology (JASN)'

the same mechanisms that are suspected in essential hypertension are also suspected at the endothelial level in many POTs patients. Reduced nitrix oxide bioavailability for various reasons is suspected in both and in congestive heart failure.

[erik]

I've had high Albumin readings (and A/G ratio) repeatedly... classic & presumed cause is dehydration (but my electrolytes are always fine and I know my hydration pretty darn well). Other measures are usually taken simultaneously that make overt kidney/liver failure evident, so that would be expected to show up beyond the A/G stuff if it were going on. I did scrounge up this info during my personal hunt:

Albumin: The Test

Certain drugs increase albumin in your blood, including anabolic steroids, androgens, growth hormones, and insulin.

This happens to me both off of and on high-salt + fludrocortisone + excellent water "hygiene/hyper-awareness". Perhaps something excreting extra amounts of one of those things is worth considering... my doc is keeping that avenue of pursuit open (while going down POTS lane). I also go through phases of water dumping and keeping up with intake... this is almost like ADH shortage (Diabedes Insipidus) at times, but it's episodic for me and apparently others with POTS too.

There is the distinct chance that this baffling indicator is a side of POTS expressed differently amongst men. We are a rarity of a rarity! Any ladies getting this indicator? It could relate to the androgen picture, as some of our metabolic pathways diverge in those regards For example, it is said that during POTS episodes, the adrenals get called to action (catecholamine burst or replenishment)... this could bring with it extra side-activity since they handle some androgen precursor stuff too... or this could make a competitive shortage which is then being (over)compensated for elsewhere and showing up in this indicator.

Did they manage to turn up anything (even speculative) with or beyond the calcium/parathyroid angle? I would really love to know too. I was considering a parathyroid hormone check too, coincidentally. Of course, I'll post if I can learn anything in my adventure. I wish you and your son well.