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Journal of Clinical Pathology.... 1973
Topics: Abetalipoproteinemia; Acyltransferases; Blood Protein Disorders; Cholesterol; Chylomicrons; Dietary Fats; Eye Manifestations; Humans; Hypoproteinemia; Infant, Newborn; Infant, Newborn, Diseases; Lipids; Lipoproteins; Malabsorption Syndromes; Mononuclear Phagocyte System; Neurologic Manifestations; Phosphatidylcholines; Phospholipids; Triglycerides
PubMed: 4517658
DOI: 10.1136/jcp.s1-5.1.53 -
Current Opinion in Allergy and Clinical... Jun 2014To raise awareness among healthcare providers about the clinical and laboratory findings in acute and chronic food protein-induced enterocolitis syndrome (FPIES). (Review)
Review
PURPOSE OF REVIEW
To raise awareness among healthcare providers about the clinical and laboratory findings in acute and chronic food protein-induced enterocolitis syndrome (FPIES).
RECENT FINDINGS
FPIES can be caused by trivial exposure or rare foods.
SUMMARY
FPIES is a non-IgE-mediated reaction that usually presents with acute severe repetitive vomiting and diarrhea associated with lethargy, pallor, dehydration, and even hypovolemic shock. Manifestations resolve usually within 24-48 h of elimination of the causative food. In chronic cases, symptoms may include persistent diarrhea, poor weight gain, failure to thrive, and improvement may take several days after the food elimination. In the acute cases, laboratory evaluation may reveal thrombocytosis and neutrophilia, peaking about 6 h postingestion. Depending on the severity, metabolic acidosis and methemoglobinemia may occur. In chronic cases, anemia, hypoalbuminemia and eosinophilia may be seen. Radiologic evaluation or other procedures, such as endoscopy and gastric juice analysis may show nonspecific abnormal findings. The diagnosis is based on clinical manifestations. Further studies looking at the phenotypes of FPIES are needed to identify clinical subtypes, and to understand the predisposing factors for developing FPIES compared with immediate-type, IgE-mediated gastroenteropathies.
Topics: Acidosis; Acute Disease; Anemia; Chronic Disease; Diarrhea; Dietary Proteins; Enterocolitis; Eosinophilia; Failure to Thrive; Humans; Hypoalbuminemia; Male; Methemoglobinemia; Syndrome; Thrombocytosis; Weight Loss
PubMed: 24651279
DOI: 10.1097/ACI.0000000000000052 -
Archives of Disease in Childhood Sep 1973A 2-year-old boy investigated because of small stature, had low serum levels of cholesterol (74 mg/100 ml) and β-lipoprotein cholesterol (20 mg/100 ml). Faecal fat,...
A 2-year-old boy investigated because of small stature, had low serum levels of cholesterol (74 mg/100 ml) and β-lipoprotein cholesterol (20 mg/100 ml). Faecal fat, jejunal biopsy, red cell morphology, and plasma growth hormone and thyroxine were normal, and it was concluded that the small stature was hereditary. A family study showed a similar lipoprotein abnormality in the patient's mother; her serum cholesterol was 83 mg/100 ml and β-lipoprotein cholesterol 34 mg/100 ml. Analysis of the β-lipoprotein fraction in both child and mother showed it to have an abnormal lipid composition; the cholesterol/phospholipid ratio was 1·0 and 0·8, respectively (normal 1·7), and within the phospholipid components the proportion of sphingomyelin was markedly reduced (11% and 5%, normal 30%). These findings differ from previous reports that the composition of β-lipoprotein is normal. Familial hypo-β-lipoproteinaemia has been shown to be inherited as an autosomal dominant, and our findings are in agreement. Although a few individuals with this condition have been reported to have some of the features associated with a-β-lipoproteinaemia, neither our patient nor his mother had any gastrointestinal, haematological, or neurological abnormalities.
Topics: Adolescent; Adult; Body Weight; Cholesterol; Female; Humans; Hypoproteinemia; Infant; Infant, Newborn; Lipoproteins; Male; Phosphatidylethanolamines; Phospholipids; Sphingomyelins; Triglycerides
PubMed: 4733643
DOI: 10.1136/adc.48.9.729 -
Journal of Artificial Organs : the... Jun 2024Excessive albumin losses during HC (haemocatharsis) are considered a potential cause of hypoalbuminemia-a key risk factor for mortality. This review on total albumin... (Review)
Review
Excessive albumin losses during HC (haemocatharsis) are considered a potential cause of hypoalbuminemia-a key risk factor for mortality. This review on total albumin losses considers albumin "leaking" into the dialysate and losses due to protein/membrane interactions (i.e. adsorption, "secondary membrane formation" and denaturation). The former are fairly easy to determine, usually varying at the level of ~ 2 g to ~ 7 g albumin loss per session. Such values, commonly accepted as representative of the total albumin losses, are often quoted as limits/standards of permissible albumin loss per session. On albumin mass lost due to adsorption/deposition, which is the result of complicated interactions and rather difficult to determine, scant in vivo data exist and there is great uncertainty and confusion regarding their magnitude; this is possibly responsible for neglecting their contribution to the total losses at present. Yet, many relevant in vitro studies suggest that losses of albumin due to protein/membrane interactions are likely comparable to (or even greater than) those due to leaking, particularly in the currently favoured high-convection HDF (haemodiafiltration) treatment. Therefore, it is emphasised that top research priority should be given to resolve these issues, primarily by developing appropriate/facile in vivo test-methods and related analytical techniques.
Topics: Humans; Hypoalbuminemia; Renal Dialysis; Serum Albumin; Dialysis Solutions; Hemodiafiltration
PubMed: 38238597
DOI: 10.1007/s10047-023-01430-y -
Journal of Applied Physiology... Jan 2023This paper describes two new features ) development of physicochemically based, two-compartment models describing acid-base-state changes in normal and abnormal blood...
This paper describes two new features ) development of physicochemically based, two-compartment models describing acid-base-state changes in normal and abnormal blood and ) use of model results to view and describe physicochemical properties of blood, in terms of Pco as the causative independent variable and effected [H] changes as the dependent variable. Models were derived from an in vitro experimental study, where normal blood was made both hypoproteinemic and hyperalbuminemic and then equilibrated with CO. Strong-ion gap (SIG) values were selected to match model and experimental pH. The effect of individual physicochemical factors affecting blood acid-base-state were evaluated from their induced changes on buffer curve linearized slope (β) and [H] curve shift at 40 mmHg ([H]). Model findings were: ) in severe hypoproteinemia, hemoglobin enhances buffering (decreases β), whereas albumin compromises it, resulting in an almost unchanged β; [H] decreases (alkalemia) due to hypoalbuminemia. ) Severe hyperalbuminemia greatly increases both β and [H], hence, compromising buffering and causing a severe acidemia. ) Pco-induced changes in the electrical-charge concentration of hemoglobin are the principal factor responsible for maintaining normal buffering characteristics in hypoproteinemia and hyperalbuminemia. ) SIG values are a third Pco-independent characteristic of blood acid-base state and ) the quantities, β+, [H], and SIG, derived from a [H] vs. Pco perspective, are a more informative and intuitive way to characterize blood acid-base state. This study represents the most up-to-date, physicochemical, multi-compartment computer model of the processes involved in determining the acid-base buffering state of blood. Previous models lack this capability, notably by being single compartment and/or lacking electroneutrality and osmotic constraints. Model results, analyzed from a different perspective of dependent [H] changes resulting from independent Pco changes, provide a new set of Pco-independent parameters, characteristic of blood buffering properties.
Topics: Humans; Hydrogen-Ion Concentration; Acid-Base Imbalance; Acidosis; Hemoglobins; Hypoproteinemia; Acid-Base Equilibrium; Carbon Dioxide
PubMed: 36519570
DOI: 10.1152/japplphysiol.00309.2022 -
International Journal of Molecular... Dec 2023This narrative review critically examines the role of albumin in sepsis management and compares it to its well-established application in liver cirrhosis. Albumin, a key... (Review)
Review
This narrative review critically examines the role of albumin in sepsis management and compares it to its well-established application in liver cirrhosis. Albumin, a key plasma protein, is effective in the management of fluid imbalance, circulatory dysfunction, and inflammation-related complications. However, its role in sepsis is more intricate and characterized by ongoing debate and varied results from clinical studies. In sepsis, the potential benefits of albumin include maintaining vascular integrity and modulating inflammation, yet its consistent clinical efficacy is not as definitive as that in cirrhosis. This review evaluated various clinical trials and evidence, highlighting their limitations and providing practical insights for clinicians. It emphasizes identifying sepsis patient subgroups that are most likely to benefit from albumin therapy, particularly exploring the correction of hypoalbuminemia. This condition, which is significantly corrected in patients with cirrhosis, may have similar therapeutic advantages in sepsis. The potential effectiveness of albumin in the low-volume resuscitation and deresuscitation phases of sepsis management was noted. Given the safety concerns observed in cirrhosis, such as pulmonary edema and hypervolemia associated with albumin therapy, cautious integration of albumin into sepsis treatment is mandatory. Personalized albumin therapy is advocated for tailoring strategies to the specific needs of each patient, based on their clinical presentation and underlying conditions. The need for further research to delineate the role of albumin in sepsis pathophysiology is underscored. The review emphasizes the importance of conducting trials to assess the effectiveness of albumin in correcting hypoalbuminemia in sepsis, its impact on patient outcomes, and the establishment of appropriate dosing and administration methods. This approach to albumin use in sepsis management is posited as a way to potentially improve patient outcomes in this complex clinical scenario while being mindful of the lessons learned from its use in cirrhosis.
Topics: Humans; Hypoalbuminemia; Albumins; Sepsis; Liver Cirrhosis; Water-Electrolyte Imbalance; Inflammation
PubMed: 38139434
DOI: 10.3390/ijms242417606 -
Nefrologia : Publicacion Oficial de La... 2011Cirrhosis represents a late stage of hepatic fibrosis and leads to high morbidity and mortality, and the most frequent complication is ascites. Only a few patients with... (Review)
Review
Cirrhosis represents a late stage of hepatic fibrosis and leads to high morbidity and mortality, and the most frequent complication is ascites. Only a few patients with advanced cirrhosis have 'refractory ascites' and do not respond to conventional treatment. Repeated paracentesis for evacuation is considered the treatment of choice in these cases. A large proportion of these patients have associated chronic kidney disease (CKD), which may require renal replacement therapy (RRT). Due to the complications associated with liver disease with coagulation disorders and tendencies towards spontaneous hypotension, there are significant problems associated to RRT, especially haemodialysis (HD). On the contrary, peritoneal dialysis (PD) offers several advantages over HD in cirrhotic patients (with or without ascites) thanks to better haemodynamic tolerance, as it is a continuous and slow technique. Furthermore, PD has a low rate of infection and bleeding.
Topics: Ascites; Blood Coagulation Disorders; Chronic Disease; Hemodynamics; Hepatitis, Viral, Human; Humans; Hypoproteinemia; Hypotension; Kidney Diseases; Liver Cirrhosis; Malnutrition; Peritoneal Dialysis; Peritonitis; Prognosis; Renal Dialysis; Risk; Survival Analysis
PubMed: 22130279
DOI: 10.3265/Nefrologia.pre2011.Jun.10901 -
Clinical Nutrition (Edinburgh, Scotland) Apr 2024Albumin is a relatively small molecule with a radius of 7.5 nm and a molecular weight of 65 kDa. It is the most abundant protein in plasma, accounting for 60-75% of...
Albumin is a relatively small molecule with a radius of 7.5 nm and a molecular weight of 65 kDa. It is the most abundant protein in plasma, accounting for 60-75% of its oncotic pressure. Its concentration in plasma is merely one static measurement reflecting a dynamic and complex system of albumin physiology, and is the net result of several different processes, one or more of which may become deranged by disease or its treatment. It is also unsurprising that hypoalbuminaemia has proved to be an indicator of morbidity and mortality risk since the underlying conditions which cause it, including protein energy malnutrition, crystalloid overload, inflammation, and liver dysfunction are themselves risk factors. In some cases, its underlying cause may require treatment but mostly it is just a parameter to be monitored and used as one measure of clinical progress or deterioration. While malnutrition, associated with a low protein intake, may be a contributory cause of hypoalbuminaemia, in the absence of inflammation and/or dilution with crystalloid its development in response to malnutrition alone is slow compared with the rapid change caused by inflammatory redistribution or dilution with crystalloids. Other significant causes include liver dysfunction and serous losses. These causal factors may occur singly or in combination in any particular case. Treatment is that of the underlying causes and associated conditions such as a low plasma volume, not of hypoalbuminaemia per se.
Topics: Humans; Hypoalbuminemia; Clinical Relevance; Albumins; Inflammation; Malnutrition; Crystalloid Solutions; Liver Diseases
PubMed: 38394971
DOI: 10.1016/j.clnu.2024.02.018 -
Alimentary Pharmacology & Therapeutics Sep 2014Obesity surgery is acknowledged as a highly effective therapy for morbidly obese patients. Beneficial short-term effects on common comorbidities are practically... (Review)
Review
BACKGROUND
Obesity surgery is acknowledged as a highly effective therapy for morbidly obese patients. Beneficial short-term effects on common comorbidities are practically undisputed, but a growing data pool from long-term follow-up reveals increasing evidence of potentially severe nutritional and pharmacological consequences.
AIMS
To assess the prevalence, causes and symptoms of complications after obesity surgery, to elucidate and compare therapy recommendations for macro- and micronutrient deficiencies, and to explore surgically-induced effects on drug absorption and bioavailability, discussing ramifications for long-term therapy and prophylaxis.
METHODS
PubMed, Embase and MEDLINE were searched using terms including, but not limited to, bariatric surgery, gastric bypass, obesity surgery and Roux-en-Y, coupled with secondary search terms, e.g. anaemia, micronutrients, vitamin deficiency, bacterial overgrowth, drug absorption, pharmacokinetics, undernutrition. All studies in English, French or German published January 1980 through March 2014 were included.
RESULTS
Macro- and micronutrient deficiencies are common after obesity surgery. The most critical, depending on surgical technique, are hypoalbuminemia (3-18%) and deficiencies of vitamins B1 (≤49%), B12 (19-35%) and D (25-73%), iron (17-45%) and zinc (12-91%). Many drugs commonly administered to obese patients (e.g. anti-depressants, anti-microbials, metformin) are subject to post-operative and/or PPI-associated changes affecting bioavailability and absorption.
CONCLUSIONS
Complications are associated with pre-operative and/or post-operative malnutrition or procedure-related changes in intake, absorption and drug bioavailability. The high prevalence of nutrient deficiencies after obesity surgery makes life-long nutritional monitoring and supplementation essential. Post-operative changes to drug absorption and bioavailability in bariatric patients cast doubt on the validity of standard drug dosage and administration recommendations.
Topics: Bariatric Surgery; Biological Availability; Deficiency Diseases; Humans; Hypoalbuminemia; Obesity, Morbid; Pharmaceutical Preparations; Pharmacokinetics; Postoperative Complications
PubMed: 25078533
DOI: 10.1111/apt.12872 -
Annals of HepatologyDecompensated liver cirrhosis has a dismal prognosis, with an overall survival of 2-4 years, which is worse than for many oncological diseases. Albumin is an important... (Review)
Review
Decompensated liver cirrhosis has a dismal prognosis, with an overall survival of 2-4 years, which is worse than for many oncological diseases. Albumin is an important tool in the management of patients with cirrhosis, since it decreases for less than half the risk for post-paracentesis cardiocirculatory dysfunction and mortality associated with spontaneous bacterial infection, as well as, it triplicates the response to terlipressin in patients with hepatorenal syndrome. Recently, research on albumin has been a hot topic, with important new insights such as the characterization of the pleiotropic effects of albumin (which surpass its oncotic properties) and the concept of effective albumin concentration. In fact, patients with liver cirrhosis present posttranslational modifications on albumin that compromises its function. Those modified albumin forms were proved to have prognostic value and its knowledge may change the paradigm of albumin treatment. In this review, we critically summarize the latest evidence on the potential benefits of albumin in patients with end-stage liver disease.
Topics: Animals; Biomarkers; End Stage Liver Disease; Humans; Hypoalbuminemia; Liver; Liver Cirrhosis; Protein Processing, Post-Translational; Serum Albumin, Human; Treatment Outcome
PubMed: 29893696
DOI: 10.5604/01.3001.0012.0916