Evaluate nutritional status; investigate edema.
In the entities which follow, the diseases listed are sometimes increased or decreased as indicated, but are not always so.
Causes of high total protein: dehydration; some cases of chronic liver disease, including chronic active hepatitis and cirrhosis; neoplasms, especially myeloma; macroglobulinemia of Waldenström; tropical diseases (eg, kala-azar, leprosy, and others); granulomatous diseases, such as sarcoidosis; diseases in which total protein is sometimes high include collagen disease (eg, systemic lupus erythematosus (SLE), and other instances of chronic infection/inflammation).
Causes of low total protein: pregnancy; intravenous fluids; cirrhosis or other liver disease, including chronic alcoholism; prolonged immobilization; heart failure; nephrotic syndromes; glomerulonephritis; neoplasia; protein losing enteropathies; Crohn’s disease and chronic ulcerative colitis; starvation, malabsorption or malnutrition; hyperthyroidism; burns; severe skin disease; and other chronic diseases.
Very low total protein (<4 g/dL) and low albumin cause edema (eg, the nephrotic syndromes).