Metabolism of Albumin and Fibrinogen in Patients with Tropical Sprue

Abstract

A detailed study of the factors affecting albumin and fibrinogen metabolism has been made in patients with tropical sprue. The synthesis of both albumin and fibrinogen was measured directly and compared to the catabolic rate and to any gastrointestinal protein loss. It was found that hypoalbuminemia in patients with tropical sprue was largely due to a reduced synthesis of albumin. Although increased gastrointestinal loss was present in half of the patients, it was not severe and was of secondary importance in producing hypoalbuminemia. Fibrinogen metabolism was also altered, with a reduction in plasma fibrinogen and total circulating fibrinogen. This reduction was perhaps the result of an earlier reduction in fibrinogen synthesis. Dilution of a normal total circulating albumin with a large plasma volume and a predominantly extravascular distribution of albumin contributed to hypoalbuminemia in some patients. Nitrogen balance studies showed that these patients had a mild increase in fecal nitrogen excretion and a reduced labile nitrogen pool.