Icterus

Recently, this problem has been approached by reverting to reading the color of the bilirubin directly. This used to be called an "Icterus Index", in which the color of the serum was compared to a dilute dichromate solution (39). However, the new approach has been to use two wavelengths. This can be used in either of two different procedures. In one procedure the reading is made at the peak for bilirubin which is at 453 nm and at an isosbestic point for hemoglobin (40). The effect on the reading due to hemoglobin is subtracted from the bilirubin value. Commercial instruments based on this principle have not been successful. 

The sinusoids transport both portal and arterial blood to the hepatocytes. The systemic blood delivered to the liver contains nutrients, drugs, and ingested toxins. The liver processes the nutrients (carbohydrates, proteins, lipids, vitamins, and minerals) for either immediate use or for storage, while the drugs and toxins are metabolized through a variety of processes known as first-pass metabolism. The liver also processes metabolic waste products for excretion. In cirrhosis, bilirubin (from the enzymatic breakdown of heme) can accumulate this causes jaundice (yellowing of the skin), scleral icterus (yellowing of the sclera), and tea-colored urine (urinary bilirubin excretion). 

Chronic obstruction of the common bile duct by the inflamed pancreas can cause icterus, cholangitis, and biliary cirrhosis.36... 

Jaundice may be evident in the whites of the eyes (scleral icterus) or skin. 

HEENT Scleral icterus, dry mucous membranes, pinpoint pupils, dilated and fixed pupils, nystagmus... 

Vitamin B12- and folate-deficiency anemias are characterized by pallor, icterus, and gastric mucosal atrophy. Vitamin B12 anemia is distinguished by neuropsychiatric abnormalities (e.g., numbness, paresthesias, irritability), which are absent in patients with folate-deficiency anemia. 

Usual clinical signs and symptoms of SCD are chronic anemia fever pallor arthralgia scleral icterus abdominal pain weakness anorexia fatigue enlarged liver, spleen, and heart and hematuria. 

Jaundice (yellow color of skin, whites of the eyes) may occur when blood levels of bilirubin exceed normal (icterus). Jaundice may be characterized by an increase in unconjugated (indirect) bilirubin, conjugated (direct) bilirubin, or both. Accumulation of bilirubin (usually unconjugiated) in the brain (kernicterus) may result in death. When conjugated bilirubin increases, it may be excreted, giving a deep yeUow-red color to the urine. Examples of conditions associated with increased bilirubin and jaundice include the following. 

The instrumental range is designed primarily for the clinical laboratories but 10 different wavelengths between 340 nm and 800 nm can be selected to match the test requirements. Sixteen photometric sensors are available. Serum quality data, including hpernia, icterus and remolysis, can be obtained in addition to the serum blank. All of this information can be obtained without sacrificing the number of channels available for chemical analysis. 

In humans, early symptoms of intoxication may include headache, dizziness, nausea, vomiting, malaise, and myoclonic jerks of the limbs clonic and tonic convulsions and sometimes coma follow and may occur without the premonitory symptoms. A suicidal person who ingested 25.6mg/kg developed convulsions within 20 minutes that persisted recurrently until large amounts of barbiturates had been administered. Hematuria and azotemia occurred the day after ingestion and continued for 18 days. Liver function studies were within normal limits except for an elevated icterus index an electroencephalogram revealed generalized cerebral dysrhythmia, which returned to normal after 5 months. ... 

Adverse reactions occurring in at least 3% of patients include the following abdominal pain, diarrhea, dizziness, headache, insomnia, jaundice/scleral icterus, myalgia, nausea, peripheral neurologic symptoms, rash, vomiting. 

Jaundice (or icterus) is defined as yellowing of the skin, scierae and fingernaii beds due to increased concentration of bilirubin in the blood (hyperbilirubinemia). 

Icterus and/or clinical tes implicating liver Other biochemical changes Loss of consciousness Convulsions... 

The skin often appears flushed, hot, and dry in poisoning with atropine and other antimuscarinics. Excessive sweating occurs with organophosphates, nicotine, and sympathomimetic drugs. Cyanosis may be caused by hypoxemia or by methemoglobinemia. Icterus may suggest hepatic necrosis due to acetaminophen or Amanita phalloides mushroom poisoning. 

Concentrated solutions of resorcinol are irritating to the skin and ingestion of large doses may induce hypothermia, hypotension, decreased respiration, tremors, icterus and haemoglobinuria in children (lARC, 1977). 

Jaundice (also called icterus) refers to the yellow color of skin, nail beds, and sclerae (whites of the eyes) caused by deposition of bilirubin, secondary to increased bilirubin levels in the blood (hyperbilirubinemia, Figure 21.10). Although not a disease, jaundice is usually a symptom of an underlying disorder. 

Definition and causes of jaundice Jaundice (icterus) refers to the yellow color of the skin, nail beds, and sclerae caused by deposition of bilirubin, secondary to increased bilirubin levels in the blood. There are three major forms of jaundice hemolytic jaundice, caused by massive lysis of red blood cells, releasing more heme than can be handled by the reticuloendothelial system obstructive jaundice, resulting from obstruction of the bile duct and hepatocellular jaundice, caused by damage to liver cells that decreases the liver s ability to take up and conjugate bilirubin. In addition, neonatal jaundice is caused by the low activity of hepatic glucuronylation of bilirubin, especially in premature infants. 

The adverse effects of atazanavir include fever, jaundice/scleral icterus, myalgia and diarrhea. Its coadministration is not recommended with the drugs that induce cytochrome P-450 isoenzyme CYP3A4. Ritonavir increases plasma concentrations of atazanavir. It is an inhibitor of isoenzymes CYP3A4, CYP2C8 and UGT1A1. The coadministration of atazanavir with calcium channel blockers, HMG-CoA reductase inhibitors, immunosuppressants and phosphodiesterase 5 inhibitors should be carefully monitored. 

A 49-year-old man developed scleral icterus with raised bilirubin and transaminases after using pioglitazone 15-30 mg for 6 months and 45 mg for 1 week (105). No other cause for hepatitis was found. After withdrawal his liver function improved substantially within 14 days. 

This toxic protein is contained in caster seeds but does not pass into the oil. Similar phytotoxins occur in croton seeds (Crotin) jequirity seeds (Abrin) the bark of the locust tree, Robinia pseudo-acacia (Robin) and in the seeds of some leguminous plants (Phasin). The last is but weakly toxic. Ricin is responsible for the toxic effects on eating castor seeds 5 or 6 of these are fatal to a child, 20 to adults, and 3 or 4 seeds may cause violent gastroenteritis with nausea, headache, persistent vomiting, colic, sometimes bloody diarrhea, thirst, emaciation, and great debility. The symptoms usually do not set in until after several days. More severe intoxications cause small frequent pulse, cold sweat, icterus, and convulsions. Death occurs in 6 to 8 d, from the convulsions or from exhaustion. The fatality rate is about 6%. This low fatality rate is due to the destruction of the poison in the alimentary canal. The treatment would be evacuant and symptomatic. Usually, 3 to 10 d are required to complete recovery. 

The use of the icterus index, as described by Meulengracht, for the assessment of jaundice has fallen into disrepute because of the errors caused by the presence of lipochromes, carotenoids, and other yellow pigments. Josephson (J6) in his survey found that the correlation coefficient between icterus index and serum bilirubin concentration was 0.69 in 360 healthy subjects and 0.84 in 40 jaundiced subjects. In newborn infants however, bilirubin is the only yellow pigment likely to be present and the possibility of determining serum bilirubin concentrations by direct measurement has again been re-examined. Abelson and Boggs (Al) diluted serum from infants with erythroblastosis 1 in 50 and studied the absorption curves. They found that in addition to the bili-... 

J6. Josephson, B., The icterus index as a measure of serum bilirubin concentration. Acta Genet. Statist. Med. 4, 231-235 (1953). 

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