Albumin As A Potential Biomarker Of Pots/oi

[ramakentesh]

http://www.circ.ahajournals.org/cgi/content/full/111/13/1574

This article got me thinking. Since I was about 14 Ive always had unusual Albumin levels - indicative of low blood volume. Perhaps, since Vandebilt suggest that nearly all patients with POTS/COI have low blood volume it might provide an easy to demonstrate biomarker?

[sue1234]

In my first thought, I know albumin has to do with protein. And I remember from college physiology(IF my memory serves me right!) that fluid follows protein. So, I assume that means if intravascular protein levels are lowish, maybe the fluid levels would follow? Like I said, my cognitive abilities have really dropped!!

[sue1234]

Now I opened the article and looked at it. I had brought this article about 1 year ago to a cardiologist, and explained to him that the one aldosterone level I had was actually LOWER than the POTS patients in the article! All he did was rerun the labs, this one came back in range, and wanted me to start some standard meds(beta blocker, anti-depressant). I didn't go back to him. I did bring up with him that I had been wondering about a pheo, as I have had some small adenoma on my right adrenal gland. I had read that in the article, a pheo could explain the lowered blood volume.

I believe, so far, my albumin levels have been normal for me.

[ramakentesh]

The problem is it appears hard to work out whether the low blood volume in POTS is caused by sympathetic overactivity or something more significant.

http://www.circ.ahajournals.org/cgi/content/full/96/2/575

This study found that plasma increases through saline infusions provided by far the best symptom relief of the treatments tried.

[sue1234]

That makes sense to me, personally! I've had POTS for almost 4 years now, and almost 2 years ago I had my thyroid removed. Of course I had fluids for about 24 hours while in the hospital. I felt the best I've ever felt since POTS began! I walked the halls without lightheadedness and my mind was SO clear! I remember walking outside of our hotel the next day and making myself sit down because I should have been lightheaded at that point, but I wasn't.

Since then, I have told each new doctor that I think I have low blood volume and tell them how well I felt with IV fluids. You'd think they would try and delve a little deeper into that, but NO. I just want a doctor to measure my blood volume and be done with it!!!!! Then we could either fix it or move on to something else.

[firewatcher]

My stats fall between the POTS patients and controls. I do know that when I was "clinically over-hydrated" on dDAVP (as shown by low SOsm, hyponatremia and the ONLY normal RBC/hematocrit) I felt much better and my headache was gone.

As far as albumin goes, I think it was just the blood particle they attached the radioactive isotope to, so that they could measure hemoconcentration/dilution.

[erik]

My doc noted my high serum albumin a while back. It was also odd in a prior ER visit unrelated to POTS. Since this is on typical blood tests I might be able to scrounge up other older values with some digging to see if it's been consistent. I do think I've had a "normal" value at least once too.

As a "forum flashback" the high albumin came up with a member's son a while back.

As best I could find high values are traditionally interpreted as indicating dehydration and docs tend to stop there. My doc mentioned something about remote chance of tumor but didn't elaborate. I did turn up some other associations with some web surfing:

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

He may have been speculating about a tumor producing some of those things, cascading to that odd indicator. Not sure... Anyway, I figure you're hunting for a sense of how many others have had this come up since it seems like a plausible marker.... so count me as one (and Lenna's son from before).

I also speculate two other "complex physiological realms" where this can get tweaked by the body. Osmotic/oncotic pressure regulation is a game in which Albumin is apparently a key player... if something is perturbed elsewhere Albumin could get adjusted to compensate via feedback signals (appropriately or inappropriately as the body sometimes does) or get shifted as an unintended side effect in response to some other tangential interaction (since almost every body regulator has spinoff or complex effects... few things are just a simple 2 player balance).

And that introduces one of my pet physiological "boogie men"... kinins. I don't know much about them, which isn't surprising... but I am intrigued because it doesn't seem like "the experts" know all that much about them either... and they play in the kidney as well as act like histamines at times without being histamines. Probably a dead end, but one of a few personal fixations for the time being! Anyway, though they're never mentioned, the kinins can be an invisible hand in the RAAS or whatever the kids are calling it nowadays. And as the article you cite aptly mentions:

"The Renin-Angiotensin-Aldosterone System plays a key role in the neurohormonal regulation of plasma volume in humans."

But that begs the bigger question, does it not??? <pause> Are we human? <pause> Sometimes I wonder.... buahahahahahahahaha!

[firewatcher]

Erik, honey, you forgot to take your meds didn't you?

We were talking about I-V (intravenous) NOT "V" the television show. Although I feel like I have the temperature regulation of a reptile, and barely feel human on some days, the "bio-suit" that I am wearing during this lifetime is definitely human...it even has opposable thumbs! It just has a glitch in the electrical system!

Back on topic, my albumin is always on the high end of normal.

[Lenna]

Erik, you remember correctly! Because we have pheos in our family, my son had a bunch of testing for that and Multiple Endocrine Neoplasia. He does not have the gene for MEN, thank goodness, and the only thing they came up with that looked slightly abnormal was high albumin, indicating dehydration (even though he drinks 3-litres of water a day).

[erik]

Cool. I'm similar and even had "High-A" while on fludro, which places me in overhydrated zone. I do recall reading that POTS/OI has been called "Idiopathic Dehydration" in the past... amongst it's many other names.

Firewatcher: Ha, you caught me. I AM indeed off my med (fludrocortisone) again, pending testing! Thankfully I'm continuing a decent run of milder symptoms... other than the nagging flashbacks of space ship travel Just kidding of course! As you already know, we don't use the slow saucers or eggs of yestermillenia... but for some reason we still get that darn orthostatic intolerance deal. Go figure! "V". Well, yes... that is a start. Just the next in a series of propaganda to recondition the humans to our presence prior to proposing our real purpose. We have come to exchange our knowledge of infinite clean energy and nearly indefinite longevity for one simple thing... we can't solve this darn orthostatic business and we need your civilization's detailed knowledge. Please notify us when you have this solved and we will have a deal! Otherwise, I'm afraid we will be contacting all your Human Resources departments which you have so conveniently set up for us to "harvest". Na no, na no.

[heiseygirl]

Cool. I'm similar and even had "High-A" while on fludro, which places me in overhydrated zone. I do recall reading that POTS/OI has been called "Idiopathic Dehydration" in the past... amongst it's many other names.

Firewatcher: Ha, you caught me. I AM indeed off my med (fludrocortisone) again, pending testing! Thankfully I'm continuing a decent run of milder symptoms... other than the nagging flashbacks of space ship travel Just kidding of course! As you already know, we don't use the slow saucers or eggs of yestermillenia... but for some reason we still get that darn orthostatic intolerance deal. Go figure! "V". Well, yes... that is a start. Just the next in a series of propaganda to recondition the humans to our presence prior to proposing our real purpose. We have come to exchange our knowledge of infinite clean energy and nearly indefinite longevity for one simple thing... we can't solve this darn orthostatic business and we need your civilization's detailed knowledge. Please notify us when you have this solved and we will have a deal! Otherwise, I'm afraid we will be contacting all your Human Resources departments which you have so conveniently set up for us to "harvest". Na no, na no.

[heiseygirl]

i just had a bunch of blood tests for my pots to try and find an underlying cause. My albumun was high also but the dr didnt seem concerned.

[iheartcats]

My doc noted my high serum albumin a while back. It was also odd in a prior ER visit unrelated to POTS. Since this is on typical blood tests I might be able to scrounge up other older values with some digging to see if it's been consistent. I do think I've had a "normal" value at least once too.

And that introduces one of my pet physiological "boogie men"... kinins.

But that begs the bigger question, does it not??? <pause> Are we human? <pause> Sometimes I wonder.... buahahahahahahahaha!

If I want to dig through prior bloodwork - what do I look for that would show me this? Is it just a blood test? Maybe I could ask for it if I haven't had it..

As for Kinins...they said that what, 90% of our DNA was just 'junk?' - And now they are like, oops, no it is not! So we shall see about all this in the future. We shall see.

[erik]

I'm looking at what is labeled "Comp Metabolic Panel" and it has stuff from sodium & other electrolytes, BUN, creatinine, glucose, Ca, proteints, down through Bilirubin (wasn't that the name of the Judge's special putter in Caddyshack?)

I had elevated "Albumin", elevated "A/G" ratio, and low "Globulin". ("A/G" is albumin/globulin ratio, of course).

This was ER doc so he's just looking for urgent stuff and went with "dehydration" (they always do, despite my politely mentioning drinking plenty of water... though technically they can be totally correct, but that's another story).

A later repeat with my primary prior & during initial fludro monitoring (to ensure no my electrolytes got deranged)... same anomaly got his attention but didn't sprout anything. "High-A" seems often dismissed or presumed to be simple dehydration (I trust docs that this is most commonly whats going on in folks they see). Beyond that, my highly "scientific" research gave me this overview back then (I am a "bookmark"er of this sort of thing... indeed that's what my life has come to... There is variety in what people say it can mean:

http://www.usc.edu/dept/gero/CBPH/biomarke...ers-Albumin.htm

http://www.drkaslow.com/html/proteins_-_al...globulins_.html

http://www.sydpath.stvincents.com.au/tests/Albumin.htm

http://www.labtestsonline.org/understandin...bumin/test.html

http://en.wikipedia.org/wiki/Human_serum_albumin

http://www.abcompany.com/docgolob/bloodchemistry.htm

(The last case gives some speculative options... but of course, they're selling something too.)

[ramakentesh]

My albumin was high even when I was drinking outrageous amounts of liquids all day long...

[Lenna]

Erik,

Thanks for those links about albumin. I read a couple of interesting things. One that really struck me is this:

Hyperalbuminemia

Typically this condition is a sign of severe or chronic dehydration. Chronic dehydration needs to be treated with zinc as well as with water. Zinc reduces cell swelling caused by increased intake of water (hypotonicity) and also increases retention of salt. In the dehydrated state the body has too high of an osmolarity and apparently discards zinc to prevent this. Zinc also regulates transport of the cellular osmolyte taurine and albumin is known to increase cellular taurine absorption.

DOES ANYONE HERE TAKE ZINC SUPPLEMENTS?

[MissPatient20]

What a coincidence!!!!!!!!

I came here TODAY because I had my blood drawn YESTERDAY and my albumin came back high!

How funny that I came here to ask about it and there was already a post on it! My doctor is stumped, but then again my doctor doesn't know anything about POTs/dysautonomia.

I also drink loads of water and my sodium and potassium tested fine...so it seems like I'm not really dehydrated...yet my body is acting like it is.

[erik]

DOES ANYONE HERE TAKE ZINC SUPPLEMENTS?

I take zinc every couple days for a couple months now (it's 50mg or 333% of RDA though I didn't pick a dosage just bought it on sale)... and I've got a D/Calcium/Miscellaneous pill with 7mg zinc in it that I tend to take daily. Adding these to my intake does happen to correlate with me feeling better for longer lately, but other key factors like added fludro + cooler weather overshadow that time span.

If taking a tally, Broken_Shell mentioned having some High-A measures too. (Hope she's hangin' in there lately.)

It also seems like albumin is one of those things that might vary (or just tests wierd) because we are so often supine... and the fluid pressures take time to adjust. I've kind of wondered if I'm properly hydrated for laying down, but dehydrated for standing up... and being supine so much makes the body tune longer term stuff (like protein levels) too much to the supine volumes.

Or... one reference mentions that:

"Albumin is crucial in the maintenance of oncotic pressure in the blood. That is to say, it keeps the fluid from leaking out into the tissues."

Would folks with "leaky veins" tend to have regulatory push to increase albumin to try to compensate or oppose the leakiness (a.k.a. oncotic pressure regulation to compensate for an imbalance)? I've heard it said POTSies have leaky veins!

Anyone else have "leaky veins" ?

Dr Grubb explianed that my Hypermobility breaks down my collagen as well as my veins failing to constrict properly will allow fluid to leak

out.

So is the body's means of regulating that particular pressure mostly accomplished by balancing the albumin vs. water proportion? What did that other site say, Albumin accounts for 80% of this pressure? So is this a "motive" behind dehydrating the body... to reduce water/increase albumin so as to increase oncotic pressure and "stop the leak"???

[ramakentesh]

Gees I like your thinking. I might follow that up. Id wager that albumin is elevated in most POTS patients but I was assuming purely because of the low volume status. I nefer thought of your line of thinking and its very interesting.

[sue1234]

When you mention "leaky veins", that makes me think of "third spacing", where, for instance, burn victims will have so much fluid shift from their vascular system to tissues(skin), that they are at severely at risk of dehydration. Like i said in my earlier post, fluid follows albumin(protein). So, why in POTS might this be happening? I know when I get hot, my hands start swelling like blown-up medical gloves! Never happened before POTS, but it obviously looks like fluid just "loose" under the skin. And then when I cool down, they unswell as fast. So, how do we keep the fluid in the vascular system?

[erik]

Rama, it would be great if you have come upon something even more useful than you had thought! If nothing else, it is fun to explore these things.

Hmm, third spacing is interesting. I do recall a Mythbusters episode where they tested the effects of "dehydrating" oneself onto the third rail! It was a fun one. I think they say pooling problems are generally associated with POTS... that does kind of support the other side of the leaky vein notion. There are so many different "compartments" (various vascular, intercell, intracell, mitochondrial, third spacing, etc.) and overlaid forces on it all (acid-base balances, hydrostatic pressures/osmotic-oncotic gradients, little pumps & permeability modulators, physical structures, temperature, etc.). Hard to picture it all in overview. Some folks suspect Endothelium defects for some key things in other disorders... even suspect in "essential hypertension".

Another angle here: If albumin accounts for 80% of oncotic pressure (anti-leak pressure, if you will)... then what accounts for the other 20%. What if there is a deficiency (either in quantity OR effect/potency) in that other 20%? Might albumin then naturally get ramped up to compensate for that as best it can? What happens if this compensation effort helps a bit, but can't attain a balance (homeostasis) or can only do so intermittently? Even if it can compensate lots of the time, wouldn't whatever feedback mechanism triggered the compensation effort be stuck in "on" most of the time... or at least more often than in normals? Is that a potential pathology of persistent physiological bias toward dehydration... and we are swimming against that steady stream (literally at times keeping up but yet always lagging. It "feels" that way subjectively.

[redoctober]

Just adding to this thread...I also have a high-normal Albumin (5.1), so the notion of hyperalbuminemia relating to dehydration is interesting to me (as well as the zinc angle). Looking back, my albumin used to be 4'ish...now my past two labs have been 5.0 and 5.1 (high end of normal).

[cmruls]

My albumin is normal and I take a zinc supplement.

[Birdlady]

I see the original post is sort of old, but I'll chime in. My albumin has never been elevated, even before my AI diagnosis when my labs were really messed up at times. Only recently I've started taking zinc because it used to make me vomit. ugh

[comfortzone]

My total protein a couple weeks ago was high - 8.2 Albumin 4.8 and Globulin I think 3.4

Has anyone's protein electrophoresis shown abnormality?

googled this..

Endothelial dysfunction has also been shown to be predictive of future adverse cardiovascular events. One of the main mechanisms of endothelial dysfunction is the diminishing of nitric oxide, often due to high levels of asymmetric dimethylarginine, which interfere with the normal L-arginine-stimulated nitric oxide synthesis. The most prevailing mechanism of endothelial dysfunction is an increase in reactive oxygen species, which can impair nitric oxide production and activity via several mechanisms.[3] The signalling protein ERK5 is essential for maintaining normal endothelial cell function.[4]