Serum bilirubin

The patient is started on fluconazole 400 mg/day, but 3 days later has persistent fever and develops hypotension and decreased urine output. Blood cultures reveal a germ tube-negative yeast growing in the blood. Laboratory studies revealed a white blood cell count of 12,300/mm3 (12x109/L), aspartate aminotransferase 68 IU/L (1.13 pKat/L), alanine aminotransferase 75 IU/L (1.25 pKat/L), alkaline phosphatase 168 IU/L (2.8 pKat/L), and normal bilirubin. Serum creatinine is 1.8 mg/dL (159 pmol/L). 

A few important substances that are routinely analyzed in a clinical laboratory with the aid of an Autoanalyzer are, namely serum-glutamic-oxaloacetic transaminase (SGOT) creatine-phophokinase (CPK) alkaline-phosphatase (AP) belonging to the class of enzymes and a host of biochemical substances, for instance bilirubin, serum albumin, blood urea nitrogen (BUN), uric acid, creatinine, total protein, glucose, cholesterol, besides a few common inorganic ions, such as Cl, Ca2+, K+, Na+. 

Population PK screening in Phase II and Phase III is useful in assessing the impact of altered hepatic function (as a covariate) in PKs, if those patients are not excluded from Phase II and III trials, and if there is sufficient PK information collected about the patients to characterize them reasonably well. If a population PK approach is used, patients in Phase II and III studies are assessed for encephalopathy, ascites, serum bilirubin, serum albumin, and prothrombin time (which are components of the Child-Pugh score) or a similar group of measures of hepatic function. The population PK study, then, would include the following features ... 

Monitoring Perform baseline measurements of hepatic enzymes, bilirubin, serum creatinine, CBC, and platelet count (or estimate) in adults treated for tuberculosis with P.1009... 

M2. Martin, N. H., Bilirubin-serum protein complexes. Biochem. J. 42, Proc. xv (1948). 

After the introduction of modem biochemical techniques (such as enzyme diagnostics, serology and immunology) into hepatology, only a few of the numerous hver function tests have prevailed. Hepatic diagnostics has been streamlined and completely redeveloped. Only the determination of bilirubin, serum iron and urinary bile pigments has remained from the first epoch. 

Bilirubin Serum bilirubin shows a pronounced and varied increase, although the conjugated bilirubin does not rise at all, or only minimally, since uptake and conjugation remain intact for a considerable period of time. 

Aspartate aminotransferase (AST, GOT at 30 C) Bilirubin, serum (adult) Total II Direct Calcium, serum (Ca +)... 

Kock et al. (1994) reported death of 7 of 20 black rhinoceroses that had been held in creosote-treated holding pens. The animals that died had uniformly swollen intensely green livers, containing excessive intrahepatic bilirubin. Serum levels of aspartate transaminase (AST) and bilirubin were also elevated. However, doses and routes of exposure were not established in this study. 

Systemic ribavirin causes dose-related anemia due to extravascular hemolysis and dose-related suppression of bone marrow. Reversible increases of serum bilirubin, serum iron, and uric acid concentrations occur during shortterm oral administration. Bolus intravenous infusion may cause rigors. In HIV-infected patients, chronic oral therapy is also associated with dose-related lymphopenia and gastrointestinal and CNS complaints, including headache, lethargy, insomnia, and mood alteration. 

Intraperitoneal administration of 0.02 mg/kg of the compound berberine daily for 1 week to adult rats resulted in a significant decrease in mean bilirubin serum protein binding due a displacement effect (Chan 1993). 

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