Urine total bilirubin

A 20-year-old man, a previously healthy student, became agitated within 4 hours of ingesting two tablets of ecstasy at the same rave. His friends reported previous uneventful use of similar amounts. He was comatose and had minimal purposeful movements and a temperature of 41.5°C. His heart rate was 200/minute and his BP 123/57 mmHg. He had hot dry skin and diffuse intermittent myoclonus. Urine toxicology was positive for ecstasy only. His glucose was 2.5 mmol/1 (42 mg/dl), platelets 80 x 109/1, sodium 148 mmol/1, creatinine 186 pmol/l (2.1 mg/dl), and total bilirubin 34 pmol/l (2.0 mg/d peak creatine kinase activity was 17 000 iu/1. He recovered with cooling. 

Determination of total bilirubin with differentiation between direct (conjugated) and indirect (unconjugated) bilirubin Determination of cholestasis-indicating enzymes (AP, LAP, y-GT) bile acids and bile pigments in the urine (s. tab. 12.6) Test for signs of haemolysis (s. tab. 12.3)... 

A 25-year-old man presented to a walk-in clinic with tea-colored urine and fatigue. He had taken Exilis for less than 3 weeks, and after taking it for 1 week he had developed nausea, vomiting, aches, and fever. His serum aspartate aminotransferase, alanine aminotransferase, and total bilirubin were 1394 U/1, 2362 U/1, and 180 pmol/1 (10.5 mg/dl) respectively. He underwent cadaveric liver transplantation. 

A 52-year-old woman presented with a 3-day history of anorexia and jaundice after receiving acupuncture twice a day for 7 weeks, performed bilaterally at the Zusanli (ST36) acupoint to a depth of 22 mm [125 ]. Electrical stimulation was performed, with the stimulation frequency fixed at 5 Hz for 20 minutes. Her aspartate aminotransferase and alanine aminotransferase activities and total bilirubin concentrations were 84 U/1, 109 U/1, and 216 mmol/1 respectively She developed pale stools, dark urine, pruritus, pedal edema, and diarrhea during the next 12 days. Her laboratory results continued to worsen. No specific therapy was provided for the severe cholestatic jaundice. Over the next 12 weeks, her symptoms and the laboratory results gradually improved. 

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