Unfortunately, the cachectic state is all too apparent to any observer. In severe chronic disease with the development of multiple organ failure, some degree of malabsorption of nutrients probably contributes to the cachectic state. The entire picture is reflected in a continuing decline of the serum albumin as the illness progresses. Conversely, an increase in serum albumin suggests an improvement in the nutritional state. As long as a patient consumes nutrition by mouth, optimizing the state of digestive secretions is probably advisable, although there may not be clinical studies demonstrating this. The Heidelburg test reflects this environment and can be used to ascertain the need for either hydrochloric acid or pancreatic enzyme supplementation.