Changes In Serum Albumin Concentrations Research Articles

Change in serum albumin and subsequent decline in functional status in older persons

This study examines whether a three-year change in serum albumin concentration is associated with subsequent decline in functional status in older persons. A total of 588 participants from the Longitudinal Aging Study Amsterdam aged 65-85 years were followed for six years. The three-year change in serum albumin was classified in four groups: chronic low (< or =43 g/L at both time points), decrease (decrease of 2.4% or more) from normal to low, decrease but still normal, and stable normal albumin (reference group). During the subsequent three years, absolute change and a decline of one standard deviation or more (termed substantial decline) in functional status was assessed. Functional status was measured in two ways: using performance tests and self-reported functional ability. Substantial decline in functional performance and functional ability was observed in 243 persons (41.3%) and 133 persons (22.6%), respectively. After adjustment for baseline functional status and potential confounders, chronic low albumin and a decrease from normal to low albumin were associated with a greater absolute decline in functional performance and in self-reported functional ability. Using the outcome substantial decline in functional status, only decrease to low serum albumin was associated with decline in functional ability [odds ratio (OR)=1.97; one-sided 95% Confidence Limit (CL)=1.09]. This study indicates that chronic low serum albumin is a determinant of decline in functional status. However, a decrease in serum albumin from normal to low levels but within the normal range was a stronger determinant of future decline in functional status. Change in serum albumin level within the normal range measured between two points in time may be used as a general marker of future functional decline.

Response:

Response:

Changes in serum albumin concentration and volume expanding effects following a bolus of albumin 20% in septic patients

Patients with systemic sepsis develop a capillary leak syndrome, and serum -albumin concentration decreases. Hyperoncotic albumin infusion can be used for volume expansion in these patients, but the degree and duration of effect are not well described. We assessed volume expansion by albumin 20% infusion and compared the retention of infused albumin in septic patients and healthy controls. We gave albumin 20%, 200 ml as a rapid infusion to 70 patients with septic shock and 26 controls. Blood samples were taken before and 1, 5, 15, 30, 60, 120 and 240 min after the infusion for measurement of serum albumin concentration and haematocrit. Haemodilution and the percentage of administered albumin remaining intravascularly at each time were calculated. The mean proportion of the increase in albumin remaining at 4 h was 68.5 (sd 10)% in septic patients and 79 (5)% in controls (P<0.001). The albumin 20%, 200 ml caused a secondary fluid resorption and volume expansion maximal at 30 min, equivalent to a 430 ml infusion in septic patients and 500 ml in controls. After giving albumin, serum albumin concentrations decrease significantly faster in septic patients than in healthy controls.

Levels of α1 acid glycoprotein and ceruloplasmin predict future albumin levels in hemodialysis patients

Serum albumin concentration predicts mortality in hemodialysis (HD) patients. While serum albumin concentration correlates with serum concentration of C-reactive protein (CRP) and is dependent upon CRP in multiple regression models in cross sectional studies, CRP does not predict future albumin levels, possibly because CRP changes rapidly, yielding large month-to-month variability in CRP. If inflammation causes rather than is simply associated with hypoalbuminemia, then changes in the levels of acute phase proteins should precede changes in serum albumin concentration. The levels of long-lived positive and negative acute-phase proteins (APPs) (C-reactive protein, ceruloplasmin, alpha1 acid glycoprotein, transferrin and albumin) were measured longitudinally in 64 HD patients and a regression model was constructed to predict future albumin levels. Normalized protein catabolic rate (nPCR) was measured monthly. The number of repeated measurements ranged from 9 to 39 in each patient (median 22 and a mean of 23 measurements). To construct a model that would predict serum albumin concentration at any time j, values of all longitudinally measured APPs, positive and negative at any time j - 1, approximately 30 days prior to time j, were used. Other demographic factors (such as, race, access type, and cause of renal failure) also were incorporated into the model. The model with the best fit for predicting serum albumin at time j included albumin, ceruloplasmin, and alpha1 acid glycoprotein measured at time j - 1. The only demographic variable with subsequent predictive value was diabetes. The finding that changes in the concentration of the long lived APPs measured one month earlier are associated with predictable changes in the future concentration of serum albumin suggest that changes in inflammation are likely to be causal in determining serum albumin concentration in hemodialysis patients.

Dilution and redistribution effects of rapid 2-litre infusions of 0.9% (w/v) saline and 5% (w/v) dextrose on haematological parameters and serum biochemistry in normal subjects: a double-blind crossover study

Although hypoalbuminaemia after injury may result from increased vascular permeability, dilution secondary to crystalloid infusions may contribute significantly. In this double-blind crossover study, the effects of bolus infusions of crystalloids on serum albumin, haematocrit, serum and urinary biochemistry and bioelectrical impedance analysis were measured in healthy subjects. Ten male volunteers received 2-litre infusions of 0.9% (w/v) saline or 5% (w/v) dextrose over 1 h; infusions were carried out on separate occasions, in random order. Weight, haemoglobin, serum albumin, serum and urinary biochemistry and bioelectrical impedance were measured pre-infusion and hourly for 6 h. The serum albumin concentration fell in all subjects (20% after saline; 16% after dextrose) by more than could be explained by dilution alone. This fall lasted more than 6 h after saline infusion, but values had returned to baseline 1 h after the end of the dextrose infusion. Changes in haematocrit and haemoglobin were less pronounced (7.5% after saline; 6.5% after dextrose). Whereas all the water from dextrose was excreted by 2 h after completion of the infusion, only one-third of the sodium and water from the saline had been excreted by 6 h, explaining its persistent diluting effect. Impedances rose after dextrose and fell after saline (P<0.001). Subjects voided more urine (means 1663 and 563 ml respectively) of lower osmolality (means 129 and 630 mOsm/kg respectively) and sodium content (means 26 and 95 mmol respectively) after dextrose than after saline (P<0.001). While an excess water load is excreted rapidly, an excess sodium load is excreted very slowly, even in normal subjects, and causes persistent dilution of haematocrit and serum albumin. The greater than expected change in serum albumin concentration when compared with that of haemoglobin suggests that, while dilution is responsible for the latter, redistribution also has a role in the former. Changes in bioelectrical impedance may reflect the electrolyte content rather than the volume of the infusate, and may be unreliable for clinical purposes.

Dilution and redistribution effects of rapid 2-litre infusions of 0.9% (w/v) saline and 5% (w/v) dextrose on haematological parameters and serum biochemistry in normal subjects: a double-blind crossover study

Although hypoalbuminaemia after injury may result from increased vascular permeability, dilution secondary to crystalloid infusions may contribute significantly. In this double-blind crossover study, the effects of bolus infusions of crystalloids on serum albumin, haematocrit, serum and urinary biochemistry and bioelectrical impedance analysis were measured in healthy subjects. Ten male volunteers received 2-litre infusions of 0.9% (w/v) saline or 5% (w/v) dextrose over 1 h; infusions were carried out on separate occasions, in random order. Weight, haemoglobin, serum albumin, serum and urinary biochemistry and bioelectrical impedance were measured pre-infusion and hourly for 6 h. The serum albumin concentration fell in all subjects (20% after saline; 16% after dextrose) by more than could be explained by dilution alone. This fall lasted more than 6 h after saline infusion, but values had returned to baseline 1 h after the end of the dextrose infusion. Changes in haematocrit and haemoglobin were less pronounced (7.5% after saline; 6.5% after dextrose). Whereas all the water from dextrose was excreted by 2 h after completion of the infusion, only one-third of the sodium and water from the saline had been excreted by 6 h, explaining its persistent diluting effect. Impedances rose after dextrose and fell after saline (P &lt; 0.001). Subjects voided more urine (means 1663 and 563 ml respectively) of lower osmolality (means 129 and 630 mOsm/kg respectively) and sodium content (means 26 and 95 mmol respectively) after dextrose than after saline (P &lt; 0.001). While an excess water load is excreted rapidly, an excess sodium load is excreted very slowly, even in normal subjects, and causes persistent dilution of haematocrit and serum albumin. The greater than expected change in serum albumin concentration when compared with that of haemoglobin suggests that, while dilution is responsible for the latter, redistribution also has a role in the former. Changes in bioelectrical impedance may reflect the electrolyte content rather than the volume of the infusate, and may be unreliable for clinical purposes.

Peritoneal transport properties and dialysis dose affect growth and nutritional status in children on chronic peritoneal dialysis. Mid-European Pediatric Peritoneal Dialysis Study Group.

To evaluate a possible effect of peritoneal transport properties and dialysis dose on the physical development of children on chronic peritoneal dialysis, a cohort of 51 children was prospectively followed for 18 mo. Peritoneal transport characteristics were assessed by serial peritoneal equilibration tests (PET), dialysis efficacy by dialysate and residual renal clearance measurements, and growth and nutritional status by the longitudinal changes (delta) of height SD score (SDS), body mass index (BMI) SDS, and serum albumin. delta height SDS was negatively correlated with the creatinine equilibration rate observed in the initial PET (r = -0.31, P < 0.05). Multiple regression analysis confirmed the negative effect of the high transporter state (partial r2 = 0.07), and disclosed an additional positive effect of dialytic C(Cr) (partial r2 = 0.11) and a weak negative effect of daily dialysate volume (partial r2 = 0.04) on delta height SDS. delta BMI SDS was strongly age-dependent (r = -0.48, P < 0.001); while relative body mass gradually increased below 4 yr of age, it remained stable in older children. Positive changes in BMI SDS were associated with rapid PET creatinine equilibration rates (univariate r = 0.35, P < 0.05) and/or large dialysate volumes (multivariate partial r2 = 0.11), suggesting a role of dialytic glucose uptake in the development of obesity. The change in serum albumin concentrations was positively correlated with dialysate volume (partial r2 = 0.14), and negatively affected by dialytic protein losses (partial r2 = 0.06). In conclusion, the peritoneal transporter state is a weak but significant determinant of growth and body mass gain in children on chronic peritoneal dialysis. Rapid small solute equilibration contributes to impaired growth but enhanced acquisition of body mass. Dialytic small solute clearance has a weak positive effect on statural growth independent of the transporter state, but does not affect body mass gain.

Serum total homocysteine concentration before and after renal transplantation

Hyperhomocysteinemia is by now an established risk factor for the development of atherosclerosis. Total homocysteine concentration (tHcy) correlates inversely with glomerular filtration rate, and it is roughly three times as high in hemodialysis patients as in healthy individuals. Therefore, tHcy would be expected to fall markedly after successful renal transplantation. The aim of the present study was to assess the changes in tHcy associated with renal transplantation. tHcy was analyzed in samples collected before renal transplantation and at six months after transplantation in 55 stable patients, all of whom were treated with cyclosporine (CS). tHcy was also analyzed in samples from 55 controls characterized by markers of renal function that matched those of the post-transplant state. At six months after transplantation, tHcy was significantly decreased as compared with pretransplant tHcy (27.7 +/- 14.8 vs. 36.9 +/- 21.3 micromol/liter, P < 0.001). Post-transplant tHcy was markedly higher than the tHcy of the control group (27.7 +/- 14.8 vs. 16.0 +/- 5.3 micromol/liter, P < 0.0001). The post-transplant change in tHcy ranged widely, the average change being a reduction of 14%. Sixteen patients (29%) actually manifested an increase in post-transplant tHcy. The post-transplant changes in tHcy correlated inversely with pretransplant tHcy (r = -0.66, P < 0.0001) and directly with the changes in serum albumin concentrations (r = 0.35, P < 0.05) and CS trough concentrations (r = 0.29, P < 0.05). A multivariate analysis, including the post-transplant changes in serum concentrations of folate and albumin as well as creatinine clearances explained 21% of the change in tHcy (P < 0.05). After inclusion of the CS concentration, an independent predictor, the model accounted for 28% of the post-transplant change in tHcy (P < 0.01). The post-transplant reduction in tHcy was far smaller than expected with respect to renal function, and the post-transplant changes in the major biochemical determinants of tHcy contributed relatively little to explain the change in tHcy. Thus, the results suggest the post-transplant introduction of one or more factors that induce an increase in tHcy. Treatment with CS appears to be such a factor.

Serum albumin and colloid osmotic pressure in survivors and nonsurvivors of prolonged critical illness.

We retrospectively compared the changes in serum albumin concentration and colloid osmotic pressure between survivors and nonsurvivors of prolonged (> or = 7 days) critical illness over a 2-year period from 1 July 1995. All patients had serum albumin measured daily, and colloid osmotic pressure measured 5 days a week, throughout their ICU admission. They received crystalloid and colloid infusions as well as parenteral or enteral feeding. Infusions of albumin were not used to treat hypoalbuminaemia. One hundred and forty-five patients were included, 66 nonsurvivors and 79 survivors. Nonsurvivors were significantly older than survivors [mean (95% CI): 58 (3.8) and 49 (4.1) years, respectively] and had a greater risk of death [mean (95% CI): 0.44 (0.06) and 0.28 (0.05); p < 0.05]. There was no significant difference in gender, APACHE II score [mean (95% CI): 22 (2.7) (nonsurvivors); 18 (2.3) (survivors)] or length of stay [median (interquartile range): 14 (9-27) days (nonsurvivors); 15 (9-26) days (survivors)]. There was no difference between the two groups in the absolute minimum serum albumin concentrations reached, the time to reach that minimum or the minimum in the first 7 days. However, nonsurvivors had a significantly lower mean serum albumin concentration: [mean (95% CI): 15.7 (5.1) g.l-1 compared with 18.3 (4.6) g.l-1 in survivors; p < 0.05]. They also had a lower recovery mean (the weighted mean after the minimum value): [mean (95% CI): 13.3 (5.1) g.l-1 (nonsurvivors) and 18.6 (5.3) g.l-1 (survivors); p < 0.01]. Analysis of colloid osmotic pressure results showed no difference between the groups in mean, minimum or recovery mean. Regression analysis of mean colloid osmotic pressure and albumin revealed that albumin only contributed 17% of the colloid osmotic pressure in these patients. The similar decrease in albumin in nonsurvivors and survivors may reflect the acute inflammatory response and/or haemodilution. However, survivors showed an ability to increase serum albumin concentrations, possibly owing to resumption of synthesis. The colloid osmotic pressure varied little between or within either group of patients, possibly because of the use of artificial colloids. There was no relationship between death and colloid osmotic pressure.

Changes in Serum Albumin Concentration and Outcome in Stroke

Changes in Serum Albumin Concentration and Outcome in Stroke

Effect of exercise and exogenous glucocorticoid on serum level of intact parathyroid hormone.

Most previous studies suggest that physical exercise, or physiological response to exercise such as cortisol and adrenaline secretion regulate parathyroid hormone (PTH) secretion in humans. To investigate the effects and possible interaction of exercise and excessive glucocorticoid on PTH secretion, we examined the serum of levels of intact-PTH, cortisol, adrenocorticotrophic hormone (ACTH), calcium, magnesium and phosphorus before and during one-hour of bicycle-ergometric exercise at 60% of maximal oxygen uptake. These exercise tests were performed on eight Chinese male volunteers aged between 20 and 25 years, once with and once without pretreatment with 0.5 mg of dexamethasone taken orally 9.5 hours in advance. The results showed that dexamethasone pretreatment significantly lowered basal levels of cortisol and ACTH, but intact PTH did not change. After 60 minutes of bicycling, intact PTH level increases by 50% of baseline both with and without dexamethasone pretreatment. Serum levels of calcium, corrected for changes in serum albumin concentration, phosphorus and magnesium also increased in both cases. This study demonstrated an increase of intact-PTH with exercise which was not associated with hypocalcemia or hypomagnesemia, and was not altered in the presence of mild exogenous glucocorticoid excess and suppressed endogenous cortisol secretion.

Improvement in Serum Albumin With Adequate Hemodialysis

■ Objective: To determine the effects of adequate hemodialysis on serum albumin in patients undergoing maintenance hemodialysis. ■ Design: Cohort analytical study. ■ Setting: Hospital-based dialysis unit. ■ Patients: All patients entering the hemodialysis program between December 1990 and June 1992 were selected for the study, and their charts were reviewed (n = 213). Patients in the program for more than 3 months and those who had serum albumin less than or equal to 35.0 g/L (3.50 g/dL) were included. Of the charts reviewed, 66 patients met the inclusion criteria: 28 transferred from other units (group 1), 30 initiated maintenance hemodialysis in the unit (group 2), and 8 received intradialytic parenteral nutrition (IDPN). ■ Main outcome measure: Blood samples were obtained each month to determine the change in serum albumin concentration. ■ Results: Serum albumin increased significantly (<i>P</i> < .0001) in 21 patients in group 1 (mean time, 8.5 ± 4.5 months) and in 23 patients in group 2 (mean time, 10.1 ± 4.2 months), with mean delivered Kt/V between 1.2 and 1.4 and mean protein catabolic rate (PCR) between 1.0 and 1.2 g/kg/d. Demographic data between the two groups were not statistically significant except for years on dialysis. Patients on IDPN (mean time, 5.75 ± 2.2 months) showed a significant increase in serum albumin (<i>P</i> < .01) with adequate hemodialysis and protein intake. ■ Conclusion: In hemodialysis patients with a low serum albumin concentration, the provision of adequate hemodialysis, protein, and calorie intake may result in an increase in serum albumin and PCR.

The urea reduction ratio and serum albumin concentration as predictors of mortality in patients undergoing hemodialysis.

Among patients with end-stage renal disease who are treated with hemodialysis, solute clearance during dialysis and nutritional adequacy are determinants of mortality. We determined the effects of reductions in blood urea nitrogen concentrations during dialysis and changes in serum albumin concentrations, as an indicator of nutritional status, on mortality in a large group of patients treated with hemodialysis. We analyzed retrospectively the demographic characteristics, mortality rate, duration of hemodialysis, serum albumin concentration, and urea reduction ratio (defined as the percent reduction in blood urea nitrogen concentration during a single dialysis treatment) in 13,473 patients treated from October 1, 1990, through March 31, 1991. The risk of death was determined as a function of the urea reduction ratio and serum albumin concentration. As compared with patients with urea reduction ratios of 65 to 69 percent, patients with values below 60 percent had a higher risk of death during follow-up (odds ratio, 1.28 for urea reduction ratios of 55 to 59 percent and 1.39 for ratios below 55 percent). Fifty-five percent of the patients had urea reduction ratios below 60 percent. The duration of dialysis was not predictive of mortality. The serum albumin concentration was a more powerful (21 times greater) predictor of death than the urea reduction ratio, and 60 percent of the patients had serum albumin concentrations predictive of an increased risk of death (values below 4.0 g per deciliter). The odds ratio for death was 1.48 for serum albumin concentrations of 3.5 to 3.9 g per deciliter and 3.13 for concentrations of 3.0 to 3.4 g per deciliter. Diabetic patients had lower serum albumin concentrations and urea reduction ratios than nondiabetic patients. Low urea reduction ratios during dialysis are associated with increased odds ratios for death. These risks are worsened by inadequate nutrition.

Hypoalbuminemia in patients receiving cisplatin: correlation between liver platinum and decrease in serum albumin.

We evaluated changes in serum albumin concentrations in 15 patients with advanced malignancy who were also receiving cisplatin. All 15 patients had serial measurements of serum albumin. The decrease in serum albumin from the time of the first dose of cisplatin to death correlated with liver platinum levels at autopsy (r = 0.46, p less than 0.05). The decrease in serum albumin concentration associated with liver platinum concentration of less than or equal to 1.5 micrograms/g was 0.16 +/- 0.23 g/dl (range 0-0.6). The decrease associated with liver platinum concentrations of greater than 1.5 micrograms/g was 1.0 +/- 0.45 g/dl (range 0.5-1.9; p less than 0.02). The decrease in serum albumin may be secondary to a hepatotoxic effect of cisplatin.

Albumin-Induced changes in the electrocardiographic QRS complex

The amplitude of the QRS wave of the electro-cardiogram was correlated with conventional serum electrolyte concentrations in 94 nonhypertensive and 53 hypertensive patients. There was a highly significant correlation of QRS amplitude with serum albumin level in both groups. There was also significant correlation with serum calcium level in the nonhypertensive group, but this significance disappeared after correction for albumin. Changes in the serum albumin level during the hospital admission of the nonhypertensive patients were positively correlated with changes in QRS amplitude. Albumin infusion into 13 healthy persons resulted in significantly increased QRS amplitude, which was related to changes in serum albumin concentration. These results suggest that changes in serum protein concentration cause changes in QRS amplitude, possibly as a result of increased conductivity.

Serum steroid binding protein concentrations, distribution of progestogens, and bioavailability of testosterone during treatment with contraceptives containing desogestrel or levonorgestrel

The oral administration of 150 micrograms desogestrel and 30 micrograms ethinyl estradiol (EE2) increases (P less than 0.001) serum concentrations of sex-hormone-binding globulin (SHBG) and corticosteroid-binding globulin (CBG), whereas treatment with 150 micrograms levonorgestrel and 30 micrograms EE2 only increases serum CBG concentrations. No changes in serum albumin concentrations occurred during or after treatment with either preparation, and increases in SHBG and CBG returned to the pretreatment values 1 month after treatment ceased. The serum distribution of levonorgestrel was unchanged during treatment, whereas the increase in serum SHBG concentrations after treatment with the preparation containing desogestrel decreased (P less than 0.001) the percentage of non-protein-bound 3-keto- desogestrel and the percentage of albumin-bound 3-keto- desogestrel but increased (P less than 0.001) the SHBG-bound fraction. Oral contraceptives containing either progestogen decrease the mean serum non-protein-bound testosterone concentrations, especially during treatment with desogestrel (P less than 0.001), and desogestrel may therefore by the more appropriate progestogen for the treatment of women prone to androgenic side effects.

The alteration of gene expression in rat liver during chemical carcinogenesis

The effect of the carcinogen 3′-methyl-4-dimethylaminoazobenzene (3′-MDAB) on the gene expression of rat liver was studied. Hybridization analysis with enriched neoplastic liver specific cDNA demonstrated a noticeable change in gene expression during liver carcinogenesis. The effect of 3′-MDAB on liver specific gene expression was also studied with albumin and α-fetoprotein (AFP) genes as models. Serum AFP levels increased dramatically during hepatocarcinogenesis. Amounts of AFP mRNA present in polysomal poly(A)mRNA were determined by translation and hybridization experiments. AFP mRNA increased in carcinogen-treated liver as the serum level of AFP increased. Increase of AFP mRNA in liver cytoplasmic RNAs can be detected as early as 18 days after feeding rats 3′-MDAB and reached peaks at 30–40 and 185 days of treatment. AFP serum level and AFP mRNA in liver cytosol decreased dramatically between these peaks, with a small amount of AFP mRNA and serum AFP detectable in rats treated with 3′-MDAB for 100 days. The increase in amount of AFP mRNA was due to an increase in transcription of the AFP gene in livers of rats treated with carcinogen. Only a slight change in serum albumin concentration and albumin mRNA in livers of rats treated with 3′-MDAB was noticed.

Serum albumin levels in cancer patients receiving total parenteral nutrition.

Serum albumin concentration is commonly used as an index of nutritional status and as an indicator of nutritional response in hospitalized patients receiving total parenteral nutrition (TPN). One hundred thirty-nine cancer patients receiving TPN for at least two weeks were studied. Albumin intake, serum albumin, fluid balance, and weight change was monitored from 14 to 100 days of TPN. Patients were classified into three groups: A) patients receiving no exogenous albumin; B) patients receiving less than 25 grams of exogenous albumin; and C) patients receiving at least 25 grams of exogenous albumin during their course of TPN. Linear regression analysis of serum albumin levels vs. time on TPN showed a minimal positive correlation for patients in groups B and C (r = 0.154 and r = 0.183, respectively). Further analysis showed a significant elevation of serum albumin levels only in patients in group C (p less than or equal to 0.05). Contingency table analysis showed statistically significant increase in the incidence of sepsis in patients treated with exogenous albumin (X2 = 10.50, df = 2, p less than 0.01). There was no relationship between the change in serum albumin concentrations and the number of patient deaths. In addition, no relationship between tumor burden and subsequent response of serum albumin levels were identified. Serum albumin levels do not increase in cancer patients receiving TPN, unless exogenous albumin is given. Serum albumin appears to be a poor index of nutritional response in cancer patients receiving TPN.

Serum cholinesterase activity in burned patients. I: biochemical findings.

The purpose of the study was to determine the magnitude and the aetiology of alterations in serum cholinesterase activity (pseudocholinesterase) in burned patients. Sixty burned patients with an estimated area of burn between 3 and 72% of body surface were investigated. Serum cholinesterase activity, serum albumin concentration and serum bilirubin were measured at various time intervals. The magnitude as well as the rate of fall of serum cholinesterase activity was found to be closely correlated with the severity of burn injury. Minimum levels were often reached 5 to 6 days after the burn injury, at which time the activity might have been depressed by more than 80 per cent. In the most severely burned patients, the activity sometimes remained low for months despite wound healing. Apart from the severity of the burn injury in the individual patient, several important factors determined the level of serum cholinesterase activity at a given time. These included the presence or absence of local or systemic infections, the event of recent surgery such as slough removal or skin grafting, and blood transfusions. The decrease in serum albumin concentration following the burn injury occurred earlier than the decrease in serum cholinesterase activity. Minimum levels were often reached during the first 24 h, after which time the concentration rose to reach fairly constant but decreased levels after 4 to 5 days. Apart from this initial phase, the changes in serum albumin concentration were roughly proportional to the changes in serum cholinesterase activity. The possible reasons for these findings are discussed.

The influence of iso-energetic amounts of sucrose and starch on serum albumin concentration and liver composition of weanling rats given a low-protein diet.

Rats were fed a 21-percent protein diet, or isoenergetic amounts of 6-percent protein diets containing sucrose or starch, for 28 days. Although growth was retarded equally by both 6-percent protein diets, the pattern and degree of change in serum albumin concentration and liver composition was different, depending on the type of carbohydrate that was fed. Sucrose resulted in a greater fall in serum albumin compared with starch, and a larger liver, with a higher DNA, protein and fat content. Possible reasons are suggested for the lower serum albumin concentrations in the rats fed the 6-percent protein diet containing sucrose.