Serum albumin (oncotic pressure) correlates with enteral feeding tolerance in the pediatric surgical patient.

The influence of serum oncotic pressure (Serum Albumin [SA]) on gastrointestinal (GI) tolerance of enteral feedings was prospectively studied in two phases. Phase I consisted of 46 patients, aged 3 months to 12 years, (mean 47 months) selected for enteral tube feeding via the stomach or small bowel. Twenty-eight patients had an SA greater than 3.0 g/dL and received 82% of predicted caloric and protein needs. Administration of the enteral diet was stopped for two or more days in four of the 28 patients because of GI intolerance. Eighteen patients had an SA less than 3.0 g/dL and received 51% of predicted protein needs. Ten of the 18 patients had diet intolerance for two or more days, (P less than .001). Student's t-test was used for data analysis. In phase II, 20 patients, aged 4 months to 14 years (mean 49 months), with an SA less than 3.0 g/dL underwent repletion with salt poor albumin as calculated by the following formula: Albumin Replacement = [3.5 g/dL--Serum Albumin (g/dL)] X [weight (kg) X 3] Mean prereplacement SA was 2.31 g/dL; immediately after replacement it was 3.43 g/dL, and 1 week later it was 3.41 g/dL. These patients received 87% of predicted calories and nitrogen and only two of 20 had diet intolerance for two or more days. These data suggest that correction of SA levels allows for better tolerance of enteral diets and that SA will remain normal after intravenous replacement if adequate nutrients are provided while correcting the SA.