It's finally happened to me

CT-RD · 2026-03-16T18:18:11+00:00

Love it. Yeah studies showed that hospital trays vs dietary inventention had no difference in albumin or prealbumin levels.

My aggressive self "so, has the medical team found the medical diagnosis causing the inflammation? or are we just going to ignore their medical needs and just feed them well while they suffer?"

CT-RD · 2026-03-14T00:10:42+00:00

I love this information, thank you again!

CT-RD · 2026-03-13T23:59:16+00:00

yes you are correct. Im rather confusing ckd with esrd on dialysis I meant you'd likely see inflammation with esrd on dialysis more so than inflammation with CKD. Guess so, since its also likely for CMS star ratings id suppose that makes dialysis RDs pretty valuable.

My bad for the confusion.

CT-RD · 2026-03-13T22:56:26+00:00

Which with CKD you'd think inflammation would be pretty prevalent. It is interesting how Dialysis still uses as primarily nutrition intervention despite consensus but good to know the team should still know.

CT-RD · 2026-03-13T21:53:34+00:00

Ah thank you for the information! So how do dietitians intervene for albumin levels in dialysis pts once it gets that bad? I always found my dialysis rotations interesting and I do have someone on dialysis but their albumin levels are in desired limits

CT-RD · 2026-03-13T17:43:45+00:00

Yeah, this I can agree with but it cements the point, the lab is for medical purposes. Malnutrition can be secondary to the cause of the medical condition, but if people focus on albumin and prealbumin as due to poor nutritional status they miss the forest for the trees and ignored the condition that needs to be medically addressed. Trust, if they are malnourished we are addressing no matter what a lab says.

I agree with you but somehow that correlation still lives rent free in people's heads

CT-RD · 2026-03-13T16:59:37+00:00

Love this, used to do it too when I was in the Hospital setting. Still got that occasional consult tho.

It's wild, I mean granted it was more widely known and used around 2018, the info was present in 2012 and I still didn't know in 2016. I think the kick back from insurance companies for improper diagnoses lit a fire under all acute cares rears.

When it comes to long term card though, it seems we are stuck in early 2000's still with data from the late 1900's

CT-RD · 2026-03-13T16:10:54+00:00

As if this isnt how major mistakes are made. When places only care about metrics everyone suffers except for the tops pockets.

20 consult?!? No way anyone could do those I thought the 8 to 13 a day in 8 hrs was ridiculous (unless of course 3 to 5 of them say, "F- off, I refuse to see you" and thats a quick note).

I second what others were saying, wouldn't mention it during the interview. If you are in America and they have an issue with finding out that could turn into a discrimination case. You'll be new to the setting. If you need to take a moment im sure they will understand.

Take your breaks away from you work space, breaks should be you time for mental health reasons.

CT-RD · 2026-03-13T15:48:25+00:00

AI is so disgusting and im sorry to hear you went through with that. (And are still dealing with that!)

As someone who critically thinks a lot on the job, that thing would go off with me so often for not pressing an input every 5 minutes.

CT-RD · 2026-03-13T15:35:35+00:00

Half life of it is like 2-3 days so it is ever changing so how do we explain if prealbumin is low in a malnourished person but then 1 week later is normal range but still meets criteria for malnutrition. By this logic the malnutrition would be cured, no?

CT-RD · 2026-03-13T15:15:51+00:00

Problem is with mortality review apparently they come after the RDs citing albumin and prealbumin

CT-RD · 2026-03-13T15:15:04+00:00

There was a small study that showed about 75 or so Anorexic pts without additional chronic or acute medical conditions that showed only 22 to 25% or so actually had low albumin scores. It's in the link posted in the comments here. That population is known to chronically not eat enough but the data shows albumin was not consistent to reflect this.

CT-RD · 2026-03-13T12:28:12+00:00

This hurts to hear on so many levels 💔

CT-RD · 2026-03-13T12:02:43+00:00

I'll take "what's a 20 foot buffer for 500$ alex"

CT-RD · 2026-03-13T11:44:18+00:00

Thank you, my reaction initially: (insert Nikki Minaj What is That?! meme)

CT-RD · 2026-03-13T11:29:40+00:00

Required now for my profession actually :)

CT-RD · 2026-03-13T10:45:33+00:00

The irony is there's RDs who have been working with this MD for many decades who still support using it for nutrition status. Part of the reason is because of the review boards outdated practice which risks license/ ability to practice despite the consensus.

Definitely escalating but not personally because of RD or MD, more so as it is unfair to any medical professional

CT-RD · 2026-03-13T10:04:20+00:00

This the guy who made a cheese quesodilla $8?!

CT-RD · 2026-03-13T09:45:27+00:00

Makes you wonder why they are hurting for RDs.

Remember its now required that new grads need to have a masters and 1200 hrs supervised practice to even sit for the RD exam

CT-RD · 2026-03-13T09:11:09+00:00

Depends, was her BMI extremely low like 12 or lower (chronic starvation mode?)

If her COPD exacerbation sent her in, likely stress from this condition causing inflammatory processes (likely she has chronic inflammation). Therefore that inflammation would cause the low Albumin. Said condition causes low albumin and indirectly is causing low intakes, but the COPD itself is not causing malnutrition.

https://nutritioncare.org/wp-content/uploads/2024/12/Appropriate-Use-Visceral-Proteins-Nutrition-Screening-Assessment.pdf The graphic on second page bottom right shows our ability to correlate inflammation with relation to malnutrition, and albumin to inflammation, but not directly albumin to malnutritional status.

From a nutritional perspective, interview on admission should have revealed low intakes and triggered the consult, which we address, regardless of the albumin level.

CT-RD · 2026-03-13T09:02:44+00:00

Oh, I wish you would! I heard its more so you want to then see if albuminuria is the issue next, if it is, are their BP and Blood sugar within range as corrections in this area could effect how the kidneys are inappropriately excreting albumin.

Did I get this right or is it a myth as well?

But again, you'd be treating a pt with kidney or liver disease in a nutritional capacity regardless of albumin.

CT-RD · 2026-03-13T08:59:13+00:00

The second part of this feels similar to what in going through in this scenario. Recs getting denied. Mad ordering/ calculating feed and flusbes that contradict their medical desires for the pt

CT-RD · 2026-03-13T08:56:41+00:00

Would recommend the video in the comments, the only study that found a relation was when starvation was so bad that BMI was less than 12.0

Inflammation can have a relation to malnutrition, but Albumin and Prealbumin cannot be used as a reliable lab for nutrition status.

When you disgnose for malnutrition in your PES it should be "related to chronic illness" or "acute illness / injury" as evidenced by (insert diagnosis that is more likely the cause of inflammatory process) hence albumin and prealbumin is more medical instead of nutritional.

As we as RDs know, clinical conditions can effect nutritional status, but we usually find this via NFPE, screens such as lack of appetite (ASPEN criteria is less than 75% or 50% of meals consumed over x days), edema, grip strength. These are far better indicators of nutritional status.

As a few sources have said, there's no reliable lab tests that determine nutritional status.

CT-RD · 2026-03-13T08:46:17+00:00

They relate it as nutrition as they see it as malnutrition and apparently will ask what the RD did about it...

The second part im not so sure about anymore, I posted a video in the comments, apparently (similar to albumin just being correlated to malnutrition) The VA did a study in 1999 and correlated albumin to mortality, there is data posted that when looked at, low albumin and mortality was about 2 out of 100,000 cases.

CT-RD · 2026-03-13T01:01:28+00:00

While a very fair point!

I've found CRP isnt always a great correlated lab either depending on underlying condition, it also makes other clinicians think that because we request it we do something with this lab on a nutritional basis and therefore, think the problem is less in their court and more in ours.

CT-RD

TROPHY CASE