| Bilirubin
Serum total bilirubin is increased in hepatocellular damage (infectious
hepatitis, alcoholic and other toxic hepatopathy, neoplasms), intra- and
extrahepatic biliary tract obstruction, intravascular and extravascular
hemolysis, physiologic neonatal jaundice, Crigler-Najjar syndrome, Gilbert's
disease, Dubin-Johnson syndrome, and fructose intolerance.
Drugs known to cause cholestasis include
the following:
aminosalicylic acid androgens azathioprine benzodiazepines
carbamazepine carbarsone chlorpropamide propoxyphene
estrogens penicillin gold Na thiomalate imipramine
meprobamate methimazole nicotinic acid progestins
penicillin phenothiazines oral contraceptives
sulfonamides sulfones erythromycin estolate
Drugs known to cause hepatocellular damage
include the following:
acetaminophen allopurinol aminosalicylic acid amitriptyline
androgens asparaginase aspirin azathioprine
carbamazepine chlorambucil chloramphenicol chlorpropamide
dantrolene disulfiram estrogens ethanol
ethionamide halothane ibuprofen indomethacin
iron salts isoniazid MAO inhibitors mercaptopurine
methotrexate methoxyflurane methyldopa mithramycin
nicotinic acid nitrofurantoin oral contraceptives papaverine
paramethadione penicillin phenobarbital phenazopyridine
phenylbutazone phenytoin probenecid procainamide
propylthiouracil pyrazinamide quinidine sulfonamides
tetracyclines trimethadione valproic acid
Disproportionate elevation of direct (conjugated) bilirubin is seen in
cholestasis and late in the course of chronic liver disease. Indirect
(unconjugated) bilirubin tends to predominate in hemolysis and Gilbert's
disease.
Decreased serum total bilirubin is probably not of clinical significance
but has been observed in iron deficiency anemia.
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