Changes in weight, fluid balance and serum albumin in patients referred for nutritional support

Background and aims: Starvation and injury impair the excretion of an exces s sodium and water load, resulting in oedema and hypoalbuminaemia, which ma y have adverse effects on gastrointestinal physiology. We have retrospectiv ely assessed clinical signs and fluid balance in 44 adult patients referred for nutritional support for greater than or equal to 10 days. Methods: Clinical evidence of oedema was noted. Oedematous patients were ma naged with a low sodium (0-50 mmol/day), low volume (2 l/day) feed. Some al so received albumin and a diuretic. Body weight was recorded daily and seru m albumin three times weekly. The lowest recorded weight during nutritional support and the weight at the time of discharge were correlated with serum albumin concentration. Results: The 21 patients with oedema had acute surgical conditions and comp lications such as sepsis while the 23 non-oedematous patients had chronic c onditions with gradual nutritional depletion. During nutritional support th e mean (SEM) weight in kg of the oedematous patients fell from 79.3 (2.9) t o 69.2 (3.2) (P < 0.00001) and subsequently rose to 70.1 (3.2) (P = 0.005). Corresponding values for the non-oedematous patients were 61.4 (4.0), 60.2 (3.9) (P > 0.05) and 61.2 (3.7) (P = 0.002) respectively. Weight reduction reflected negative salt and water balance and correlated with a rise in se rum albumin (r = -0.61 for oedematous and r = -0.65 for non-oedematous pati ents) largely reflecting reversal of previous dilution. Conclusion: These findings have important implications for the salt and wat er content of perioperative fluid and nutritional prescriptions. They also emphasize the dilutional component of hypoalbuminaemia in these patients.