Urine bilirubin

Condition Serum Bilirubin Urine Urobilinogen Urine Bilirubin Fecal Urobilinogen... 

Phenothiazines may increase serum cholesterol, spinal fluid protein, and urinary urobilinogen levels decrease protein bound iodine yield false-positive urine bilirubin tests interfere with urinary ketone and steroid determinations. 

Hemolytic anemia is not a common cause of anemia, but should be considered in patients with elevated serum bilirubin or urine bilirubin levels. Lysis of the erythrocyte can occur from various mechanisms such as medications, antibodies against red blood cells, infection, coagulopathy, and mechanical processes such as abnormal heart valves, and enzyme deficiencies of the red blood cell. Patients may notice fatigue, dizziness from the anemia, and dark colored (classically coke-colored urine) from the bilirubinuria. 

Bilirubinoids are coloured compounds occurring in vertebrates, in some invertebrates and even in algae. They are formed by the biological oxidation of porphyrins. The most important representative is the orange-coloured bilirubin. It occurs in the bile and in gallstones and is excreted in the faeces and in urine. Bilirubin was first isolated by Staedeler (1864) and can be purified via its crystalline ammonium salt. It is oxidized to blue-green biliverdine by iron(III) chloride ... 

Conjugated hyperbilirubinemia commonly results from blockage of the hepatic or common bile ducts, most often due to a gallstone or to cancer of the head of the pancreas. Because of the obstruction, bilirubin diglu-curonide cannot be excreted. It thus regurgitates into the hepatic veins and lymphatics, and conjugated bilirubin appears in the blood and urine (choluric jaundice). 

The commonest causes of obstructive (posthepatic) jaundice are cancer of the head of the pancreas and a gallstone lodged in the common bile duct. The presence of bilirubin in the urine is sometimes referred to as choluria—therefore, hepatitis and obstruction of the common bile duct cause choluric Jaundice, whereas the Jaundice of hemolytic anemia is referred to as acholuric. The laboratory results in patients with hepatitis are variable, depending on the extent of damage to parenchymal cells and the extent of micro-obstruction to bile ductules. Serum levels of ALT and AST are usually markedly elevated in hepatitis, whereas serum levels of alkaline phosphatase are elevated in obstructive liver disease. 

In jaundice secondary to hemolysis, the increased production of bilirubin leads to increased production of urobilinogen, which appears in the urine in large amounts. Bilirubin is not usually found in the urine in hemolytic jaundice (because unconjugated bihmbin does not pass into the urine), so that the combination of increased urobilinogen and absence of bihmbin is suggestive of hemolytic jaundice. Increased blood destruction from any cause brings about an increase in urine urobilinogen. 

In the hver, bilirubin is made water-soluble by conjugation with two molecules of glucuronic acid and is secreted into the bile. The action of bacterial enzymes in the gut produces urobihnogen and urobihn, which are excreted in the feces and urine. 

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). 

Rifabutin Adults0 5 mg/kg (300 mg) Children Appropriate dosing unknown Hematologic toxicity, uveitis, gastrointestinal symptoms, polyarthralgias, hepatotoxicity, pseudojaundice (skin discoloration with normal bilirubin), rash, flulike syndrome, orange discoloration of bodily fluids (sputum, urine, sweat, tears) Drug interactions are less problematic than rifampin... 

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). 

Due to the difficulty in obtaining sufficient volumes of urine in dogs over short collection periods, urine is usually collected overnight (approximately a 16- to 17-h period) in metabolism cages. It is recommended that a sample for urinalysis be taken early in the collection process, and that all samples be collected in fight-resistant containers to help avoid problems such as dissolution of urine casts, increased bacterial activity, and breakdown of bilirubin with exposure of the sample to fight. 

Bacterial action in the large gut converts the conjugated bilirubin into bilinogens and then to yellow-brown coloured bilins which finally leave the body through in the faeces (as stercobilin) and urine (as urobilin). A small proportion of the bilin produced in the gut is passively reabsorbed into the portal system and re-excreted as the blood flows through the liver. 

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. 

In a human case involving ingestion of approximately 1-1.5 mg/kg, effects consisted of nausea, vomiting, and green-gray urine. Clinical changes included proteinuria and elevated serum levels of bilirubin, creatine, alkaline... 

H16. Holton, J. B., and Lathe, G. H., Inhibitors of bilirubin conjugation in new-born infant serum and male urine. Clin. Sci. 25, 499-509 (1963). 

MIO. Michaelsson, M., Bilirubin determination in senim and urine. Scand. J. Clin. iMb. Invest., Suppl. 56, 3-80 (1961). 

Drug/Lab test interactions Thiazides may decrease serum PBI levels without signs of thyroid disturbance. Thiazides also may cause diagnostic interference of serum electrolyte, blood, and urine glucose levels (usually only in patients with a predisposition to glucose intolerance), serum bilirubin levels, and serum uric acid levels. In uremic patients, serum magnesium levels may be increased. Bendroflumethiazide may interfere with the phenolsulfonphthalein test due to decreased excretion. In the phentolamine and tyramine tests, bendroflumethiazide... 

Lab test abnormalities Aminosalicylic acid has been reported to interfere technically with the serum determinations of albumin by dye-binding AST by the azoene dye method and with qualitative urine tests for ketones, bilirubin, urobilinogen, or porphobilinogen. 

Cholestatic hepatitis may occur when drug therapy lasts longer than 10 days or repeated courses are prescribed. The hepatitis is characterized by fever, enlarged and tender liver, hyperbilirubinemia, dark urine, eosinophilia, elevated serum bilirubin, and elevated transaminase levels. Hepatitis has been associated with the estolate salt of erythromycin but not with other formulations. Although the hepatitis usually occurs 10 to 20 days after the initiation of therapy, it can occur within hours in a patient who has had such a reaction in the past. The hepatitis is believed to be the result of both a hepatotoxic effect and a hypersensitivity reaction this latter effect is reversible on withdrawal of the drug. Erythromycin and derivatives induce hepatic microsomal enzymes and interfere with the actions of various drugs, including theophylline and carbamazepine. 

CBC, liver and renal function test results, urine output, BUN level, and serum alkaline phosphatase, bilirubin, and creatinine levels... 

Mydriasis may occur and may precipitate an attack of acute glaucoma in some patients. Other reported but rare adverse effects include various blood dyscrasias a positive Coombs test with evidence of hemolysis hot flushes aggravation or precipitation of gout abnormalities of smell or taste brownish discoloration of saliva, urine, or vaginal secretions priapism and mild—usually transient—elevations of blood urea nitrogen and of serum transaminases, alkaline phosphatase, and bilirubin. 

Bilirubin The detection of even trace amounts of bilirubin in the urine is abnormal. 

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