Hypoproteinemia: Definition, Description, Causes and Risk FactorsICD-10-DC: E77.8/E90*Abnormally small amounts of total protein in the circulating blood plasma.One common cause of hypoproteinemia is kidney failure, where damaged kidneys start leaking proteins into the urine, causing proteinuria. Malnutrition can be a cause, with the patient not getting enough protein in the first place. Protein-losing enteropathies, where the gut eliminates protein instead of retaining it, are another potential reason to develop changes in blood protein. Lymphangiectasia, a widening of a lymph vessel, is an example of a protein-losing enteropathy. Severe burns have also been linked with hypoproteinemia.A consideration of the clinical and experimental findings indicates that loss and lack of protein may be significant factors in the production of a hypoproteinemia. However, such a simple concept does not fit all the facts. Evidence is cited in support of the hypothesis that some other factor, such as an impairment of or an injury to a specific mechanism responsible for the formation of serum protein, may play an accessory, if not the primary, role in the production and persistence of a hypoproteinemia. It is believed that the adequate approach to the solution of the problem of hypoproteinemia may well include attempts to find a way for stimulating internally the serum protein regenerating mechanism, which seems to involve in some manner the capacity of the tissues to furnish protein for the needs of the plasma. The present practice of feeding relatively high-protein diets in cases of hypoproteinemia, especially when the condition is associated with prolonged loss of protein in the urine, should be looked upon merely as a temporary expedient, not only because such a procedure is based upon the belief that the proteinuria is solely responsible for the onset and persistence of the hypoproteinemia but also because the consumption of such a ration may possibly operate as part of a vicious cycle and eventually be actually injurious to the individual.The outcome of hypoproteinemia is dependent on the prognosis for the individual's primary disease. In protein-losing gastroenteropathy, more than 50% of patients experience improvement in protein loss, edema and associated problems when the underlying condition is treated.In the long term, hypoproteinemia can be dangerous. The lack of protein in the blood will lead to muscle wasting and other problems. The untreated underlying condition can also become worse and may develop complications. If patients are allowed to become extremely ill, a cascading series of medical problems can develop and there is a risk of death.Hypoproteinemia is significantly correlated with fluid retention and weight gain, development of ARDS (acute respiratory distress syndrome) and poor respiratory outcome, and mortality in patients with sepsis. Prospective, randomized trials of serum protein manipulation are needed to establish whether there is a cause-effect relationship to this association.Symptoms:A person with hypoproteinemia may present with a variety of signs and symptoms including swelling of the lower legs (dependent edema), face or arm(s); diarrhea, or abdominal pain.Diagnosis:hypoproteinemiaRoutine blood testing sometimes identifies protein levels slightly lower than normal, and a doctor may recommend further testing to find out more if there is not an obvious cause. In other cases, a doctor may suspect hypoproteinemia and specifically request the test as part of a diagnostic workup, as in cases where a patient has symptoms of a disease associated with low blood protein. The test will also provide a breakdown of the concentrations of different kinds of proteins so doctors can see if the proportional values remain the same, or if one protein is unusually low or high.Hypoproteinemia can be confirmed by blood tests for serum albumin and total protein levels. A comprehensive metabolic panel, magnesium and calcium levels, a complete blood count (CBC), serum protein electrophoresis, C-reactive protein, prothrombin time (PT) and partial prothrombin time (PTT), iron and iron-binding capacity, thyroid function, fecal occult blood testing, and urinalysis are usually performed as part of a complete workup. Levels of other specific blood proteins such as gamma globulins (IgG, IgA, IgM), ceruloplasmin, alpha-1 antitrypsin, fibrinogen, transferrin, and hormone-binding proteins may also be measured, depending on the cause of the hypoproteinemia. Other tests for bacterial, viral, toxic and parasite causes may be necessary.Treatment:Since hypoproteinemia is usually a sign of an underlying disease, treatment is directed at the disease process itself. A low-fat diet rich in proteins is followed to get relief from symptoms. There are some fats called medium-chain triglycerides which can be absorbed by the blood directly without the aid of the lymphatic system. The diet can be supplemented by medium chain triglycerides, and also other minerals and vitamins to prevent deficiency diseases.Albumin and furosemide therapy improves fluid balance, oxygenation, and hemodynamics in hypoproteinemic patients with acute lung injury. Determining the effect of this simple therapy on cost, outcomes, and other patient populations requires further study.Supportive care is very important in minimizing secondary complications. Diuretics and support stockings may be helpful in some individuals. Excellent skin care will prevent cuts and skin tears, thereby decreasing the possibility of skin infections (cellulites). Adequate exercise is crucial in reducing the risk for clot formation in the legs.NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.


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