We describe five patients who developed acute kwashiorkor-like hypoalbuminemia during their hospitalization in the intensive care unit. With the initiation of enteral alimentation, diarrhea ensued and continued for at least 48 hours. Routine evaluation for the cause of diarrhea including stool culture for enteric pathogens, white blood cells, ova and parasites, Clostridium difficile cytotoxin, and flexible sigmoidoscopy was negative. When a peptide based formula (Vital HN, Ross Laboratories, Columbus, OH) was initiated, there was a significant reduction in stool output within 24 hours. In three of the five cases, hypoalbuminemia corrected within 2 weeks. Four of the five patients were discharged from the hospital. Although several reports have acknowledged the association between hypoalbuminemia and impaired gastrointestinal absorption, no previous enteral formula has been tolerated in these acutely ill patients until serum albumin levels had improved. Further studies will be required to confirm the better gastrointestinal tolerance of this peptide based formula in patients with severe hypoalbuminemia.