A clinician measures serum albumin of a child with generalized pitting edema and suspects kwashiorkor. If albumin falls from a normal 4.0 g/dL to 1.5 g/dL, explain qualitatively how this change affects oncotic pressure and fluid distribution, and recommend one immediate nutritional priority.

• A. A fall in albumin increases plasma oncotic pressure, drawing fluid back into the vasculature and resolving edema spontaneously; therefore no nutritional intervention is urgently needed.
• B. Lower albumin increases blood viscosity which alone explains edema; priority is to restrict dietary protein to prevent further viscosity changes.
• C. This albumin change is unlikely to influence fluid distribution; edema should be managed only with aggressive diuretics while ignoring nutritional status.
• D. A drop in albumin markedly lowers plasma oncotic pressure, promoting fluid shift into interstitial spaces and causing edema; immediate priority is to carefully initiate calorie- and protein-adequate therapeutic feeding to restore plasma proteins while monitoring for refeeding complications.

Answer: (D)