From the Guidelines
Elevated bilirubin levels require immediate medical attention to determine the underlying cause and provide appropriate treatment, as they can indicate liver dysfunction, bile duct obstruction, or excessive red blood cell destruction. Bilirubin is a yellow compound produced when red blood cells break down, and elevated levels can cause visible jaundice, with normal total bilirubin ranges from 0.3-1.0 mg/dL, and levels above 2.0 mg/dL often causing visible jaundice 1.
Causes and Diagnosis
The most common cause of an isolated elevated bilirubin concentration is Gilbert’s syndrome, which is an inherited disorder of metabolism and leads to impaired conjugation via reduced activity of the enzyme glucuronyltransferase 1. Except in the neonatal period, the majority of measurable bilirubin should be conjugated, even in individuals with significant liver disease. Hence if the majority of the elevated bilirubin comprises the unconjugated fraction then the cause, in the absence of haemolysis, is virtually always Gilbert’s syndrome.
Treatment and Management
Treatment depends entirely on the diagnosis - for example, gallstones blocking bile ducts may require surgical removal, while viral hepatitis might need antiviral medications 1. Hemolytic conditions causing increased red blood cell breakdown might require different interventions. While waiting for medical care, stay hydrated and avoid alcohol or medications that could further stress your liver. Elevated bilirubin can range from benign conditions like Gilbert's syndrome, which requires no treatment, to serious liver diseases requiring immediate intervention, making professional medical assessment essential.
Special Considerations
In neonates, phototherapy is an essential intervention for severe hyperbilirubinemia, especially in those at high risk, with the timing of intervention guided by performing serial measurements of total serum bilirubin concentrations and screening for the presence of intrinsic risk factors for bilirubin neurotoxicity 1. The American Academy of Pediatrics recommends promoting and supporting successful breastfeeding, performing a systematic assessment before discharge for the risk of severe hyperbilirubinemia, providing early and focused follow-up based on the risk assessment, and treating newborns with phototherapy or exchange transfusion to prevent the development of severe hyperbilirubinemia and, possibly, bilirubin encephalopathy (kernicterus) 1.
Key Recommendations
- Consult a healthcare provider immediately if you have elevated bilirubin levels, especially if you notice yellowing of the skin or eyes (jaundice) 1.
- Stay hydrated and avoid alcohol or medications that could further stress your liver while waiting for medical care.
- Prompt medical evaluation is necessary to determine the cause and provide appropriate treatment for elevated bilirubin levels.
From the Research
Elevated Bilirubin Treatment
- Elevated bilirubin, also known as hyperbilirubinemia, can be treated with phototherapy, which is effective but may have short-term and long-term harms 2.
- Ursodeoxycholic acid (UDCA) has been studied as an adjuvant treatment to phototherapy for neonatal hyperbilirubinemia, with some studies showing it can decrease total bilirubin levels faster and shorten phototherapy duration 2, 3, 4.
Ursodeoxycholic Acid (UDCA) Effects
- UDCA has been shown to reduce bilirubin levels in neonates on phototherapy, with a mean decrease in total bilirubin level of 2.06 mg/dL at 24 hours 2.
- A randomized controlled clinical trial found that administering UDCA plus phototherapy reduced total serum bilirubin (TSB) and length of hospital stay with proper safety and efficacy 3.
- Another study found that UDCA accentuates the reductive effect of phototherapy on TSB in neonates, reducing the duration of treatment and in-patient care 4.
Primary Biliary Cirrhosis Treatment
- UDCA has been used to treat primary biliary cirrhosis (PBC), with some studies showing improvement in serum enzyme values but not survival, symptoms, serum bilirubin levels, or liver histology 5, 6.
- Long-term UDCA therapy has been shown to improve bilirubin and alkaline phosphatase concentrations, but did not alter disease progression in PBC patients 6.