Following are differential diagnoses, listed in order of likelihood, for patients presented with hypoalbuminemia.

• Increased loss

  • Protein-losing nephropathy (eg, glomerulonephritis, Lyme nephritis)

  • Protein-losing enteropathy (eg, inflammatory bowel disease, lymphangiectasia)

  • Hemorrhage

  • Severe exudative dermatitis (eg, large burns or wounds, snakebites)

• Decreased production

  • Acute phase reaction (albumin is a negative acute phase protein)

  • Liver dysfunction/failure

  • Secondary to hyperglobulinemia (ie, albumin is downregulated due to increased oncotic pressure from increased globulins)

  • Starvation (ie, chronic, severe malnutrition)

• Excessive fluids (dilutional effect)

• Hypoadrenocorticism

• Sequestration (eg, secondary to loss in protein-rich effusions), third-spacing

• Hemophagocytic histiocytic sarcoma

• Increased catabolism (poorly characterized)