# Situation: A 78-year-old woman who lives alone is admitted with community-acquired pneumonia. Her daughter reports that she has eaten very little for the past 10 days. Her recorded weights are: 6 months ago, 53.0 kg; 3 months ago, 52.0 kg; 1 month ago, 48.9 kg; today, 46.5 kg. She is 1.55 m tall and has no edema. She receives antibiotics, and nasogastric feeding is started and advanced as planned. Her results are: Day 1 — albumin 2.9 g/dL (3.5–5.0 g/dL); prealbumin 11 mg/dL (15–36 mg/dL); C-reactive protein 148 mg/L (normal < 5 mg/L) Day 4 — albumin 2.7 g/dL; prealbumin 13 mg/dL; C-reactive protein 62 mg/L A student nurse says the falling albumin shows the feeding is failing. Which interpretation is MOST accurate?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630478  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 78-year-old woman who lives alone is admitted with community-acquired pneumonia. Her daughter reports that she has eaten very little for the past 10 days. Her recorded weights are: 6 months ago, 53.0 kg; 3 months ago, 52.0 kg; 1 month ago, 48.9 kg; today, 46.5 kg. She is 1.55 m tall and has no edema.

She receives antibiotics, and nasogastric feeding is started and advanced as planned. Her results are:
Day 1 — albumin 2.9 g/dL (3.5–5.0 g/dL); prealbumin 11 mg/dL (15–36 mg/dL); C-reactive protein 148 mg/L (normal < 5 mg/L)
Day 4 — albumin 2.7 g/dL; prealbumin 13 mg/dL; C-reactive protein 62 mg/L
A student nurse says the falling albumin shows the feeding is failing. Which interpretation is MOST accurate?

## 보기

1. Albumin is now the better marker, because her inflammation is resolving
2. Her falling albumin shows the feeding is inadequate and must be increased
3. Her rising prealbumin proves her protein stores are already being rebuilt
4. Both proteins mainly track inflammation; intake and weight guide the plan **✔ 정답**

**정답: 4**

## 해설

Albumin and prealbumin are negative acute-phase proteins: they fall with inflammation and rise as it settles, so they cannot judge nutrition on their own. The small prealbumin rise parallels the fall in C-reactive protein, and albumin, with a half-life of about 3 weeks and sensitivity to fluid shifts, cannot reflect 3 days of feeding. Adequacy of feeding is judged by intake, weight, and physical findings.

## 심화 해설

What the numbers really show
Both albumin and prealbumin (transthyretin) are negative acute-phase proteins. During inflammation the liver reprioritizes protein synthesis toward positive acute-phase proteins such as C-reactive protein, and production of albumin and prealbumin falls; capillary leak also moves albumin out of the bloodstream. On day 1 her C-reactive protein is 148 mg/L, showing intense inflammation from pneumonia, so low albumin (2.9 g/dL) and low prealbumin (11 mg/dL) mainly reflect that inflammation. These proteins track the inflammatory response, so they cannot judge whether her feeding is working.

Why albumin cannot reflect 3 days of feeding
Albumin has a long half-life of about 3 weeks, so a change over 3 days cannot reflect what she has been fed. It is also sensitive to fluid status; intravenous fluids and capillary leak dilute or redistribute it. The fall from 2.9 to 2.7 g/dL is therefore expected in an acutely ill client and does not mean the feeding is failing. Prealbumin has a shorter half-life, and its small rise from 11 to 13 mg/dL parallels the fall in C-reactive protein from 148 to 62 mg/L. It shows that inflammation is settling, not that protein stores have been rebuilt.

| Marker | Day 1 | Day 4 | Best explanation |
| --- | --- | --- | --- |
| Albumin | 2.9 g/dL | 2.7 g/dL | Long half-life; affected by inflammation and fluid shifts |
| Prealbumin | 11 mg/dL | 13 mg/dL | Rises as inflammation settles |
| C-reactive protein | 148 mg/L | 62 mg/L | Inflammation improving but still far above normal |

Why the other interpretations are wrong
Saying the feeding is inadequate and must be increased acts on a marker that cannot answer the question, and increasing the rate in a refeeding-risk client could be harmful. Claiming the rising prealbumin proves repletion over-reads a small change that is explained by falling inflammation. Saying albumin is now the better marker ignores that her C-reactive protein is still more than ten times the upper limit and that albumin's half-life has not changed. Watch out! A student who equates low albumin with malnutrition is applying an outdated idea; current practice does not use these proteins alone to diagnose or monitor malnutrition.

What the nurse uses instead
Adequacy of nutrition support is judged by actual intake compared with the prescribed amount, serial body weight, and physical findings such as muscle and fat loss, fluid status, and functional strength. Key point! Interpret albumin and prealbumin together with C-reactive protein, and judge the feeding plan by intake, weight, and the physical examination.

## 임상 시나리오

Interpreting Albumin and PrealbuminNutrition markers during inflammation
Albumin and prealbumin are negative acute-phase proteins: they fall with inflammation and rise as it settles. Her C-reactive protein of 148 mg/L explains the low values on day 1.

Albumin has a half-life of about 3 weeks and shifts with fluid status, so a fall over 3 days does not show feeding failure. The small prealbumin rise parallels the fall in C-reactive protein.

Judge feeding adequacy by intake versus prescription, serial weights, and physical findings.

CautionDo not increase feeding rates on the basis of falling albumin alone, especially in a client at risk of refeeding syndrome.

## 핵심 개념

- **Negative acute-phase protein** — A plasma protein whose level falls during inflammation, such as albumin and prealbumin.
- **Prealbumin** — Transthyretin, a liver protein with a short half-life that falls in inflammation and is not a reliable stand-alone nutrition marker.
- **C-reactive protein** — A positive acute-phase protein made by the liver that rises quickly with inflammation or infection.
- **Half-life** — The time it takes for the level of a substance in the body to fall by half.
- **Albumin** — The main plasma protein, with a half-life of about 3 weeks, affected by inflammation, liver function, and fluid status.

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