May 2005, Volume 35 Number 5 , p 70 - 71
Outline Initial screening
Better patient care
Who's at risk?
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Graphics Table. Gauging nutri...
YOUR NEW PATIENT, Estelle Braun, 78, was admitted to your unit last night after she fractured her hip. To meet standards set by the Joint Commission on Accreditation of Healthcare Organizations, you must screen her nutritional status within 24 hours of admission and then assess her status if she's at risk.
Prealbumin values are now considered the gold standard for assessing and monitoring the nutritional status of a patient like Mrs. Braun. (See Who's at risk? ) By tracking prealbumin levels, you can identify nutritional deficiencies early and help your patient recover more quickly and lower her risk of complications.
Prealbumin levels indicate visceral protein status. Because of prealbumin's short (2-day) half-life and relatively rapid response to protein depletion, it's sensitive to acute changes in nutrition. Prealbumin levels are also less influenced by liver disease than are other serum proteins, so fluctuations may be more specific to nutritional status.
Although its name may suggest it, prealbumin isn't a precursor to albumin. Because albumin has a longer half-life (20 days) and a large serum pool, changes in albumin levels lag behind actual changes. It's a better marker of chronic, rather than acute, malnutrition.
Prealbumin is produced by cells in both the liver and the gastrointestinal mucosa. Prealbumin, also known as transthyretin, attaches to retinol-binding protein and is a major transporter for thyroxine and vitamin A.
Protein-calorie malnutrition (PCM), an imbalance between nutritional intake and body protein requirements, affects 30% to 50% of all hospitalized patients at ...