low albumin

One should not use IV albumin for nutritional reasons, it is very short acting and falsely increases albumin level in the blood. The best way to increase a renal patients albumin level is through the gut.
If the patient refuses to eat, maybe you should consider tubing feeding with Nepro or consider trying IDPN (Intradialytic parenteral nutrition). However, IDPN can cause liver function abnormalities over a long period of time.
Your best bet is to encourage the patient to eat protein rich foods.

I think you have to realize that low albumin is a predictor of high mortality. If the pt is AAOx3 and simply "can't" eat, then I would consider uremia to be a factor: is the pt receiving adequate dialysis? If the pt wants to try to improve their albumin then tube feeding MIGHT be an option but almost always results in diarrhea which can be disturbing. Other things to consider would be depression, another co-morbidity such as CHF or COPD making eating difficult. If they are diabetic, is their hgbA1C in range?

this may be a digestion issue, perhaps low stomache acid, perhaps lacking pancreatic enzymes. it wont make any difference how much goes in, if the body cant break it down and absorb it....

Almost all of my patients (end stage heart failure) have cardiac cachexia as well as renal insufficiency. Many have pre-albumins <8 which is VERY low. Agree that IV albumin is not the answer. They need to increase their muscle mass. We do aggressive physical rehab (cardio and light weights), get a meal plan to increase protein ++ and if that still doesn't get PA up, we do overnight tube feeds. Low PA and BMI is strongly associated with HF mortality.

ESRD pts who also have liver failure are the hardest- their colloidal oncotic pressures are so low because high protein diet and admin of albumin are usually contraindicated in liver pts (due to resulting high ammonia levels and hepatic encephalopathy), but adequate albumin levels are needed to maintain colloidal pressures and keep the excess fluid in the vasculature so dialysis can remove it- not possible with liver pts.
They will have very low bps, and the lower half of their bodies are usually full of fluid that you can't touch w/ dialysis
You can't win w/ these pts. They usually don't last very long.

If a patient has pancreatitis, receiving TPN & IV ATB's at home with a HHN, and having very little oral intake like small amounts of broth, what causes the patient to have constant diarrhea? I have seen alot of patients who are declining rapidly & have almost stopped eating, but have terrible diarrhea. Where is it coming from and can anything be done about it?

Couldn't agree more.. have had several of these.. very sad cases.

? progressing to multiorgan failure (RRT + paracentesis),cachexic. TPN while on dialysis as nutritional support. Maintain comfort through dialysis and paracentesis
and ensure adequate pain control .