Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatmentSummary
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
Summary
High bilirubin levels, orhyperbilirubinemia, means you have an excessive accumulation of bilirubin.
A build-up of excess bilirubin causesjaundice—a condition that causes the skin, mucous membranes, and white part of the eyes to take on a yellow hue.
High bilirubin is common in newborns because their liver is still learning how to efficiently clear bilirubin. In adults, high bilirubin may indicate an underlying health condition, such as gallstones or liver problems.
This article discusses high bilirubin levels. It explains the symptoms and causes of hyperbilirubinemia and how it is diagnosed and treated.
Oktay Ortakcioglu/E+ / Getty Images
Symptoms of High Bilirubin
The excessive buildup of bilirubin can causejaundice. Signs of jaundice include:
Difference Between Jaundice and HyperbilirubinemiaJaundice is a symptom of high bilirubin levels, which may indicate an underlying health condition. Keep in mind that high bilirubin levels may occur without any symptoms.
Difference Between Jaundice and Hyperbilirubinemia
Jaundice is a symptom of high bilirubin levels, which may indicate an underlying health condition. Keep in mind that high bilirubin levels may occur without any symptoms.
In addition to jaundice, you may have other symptoms related to the underlying cause of hyperbilirubinemia, such asanemiaorliver disease. These include:
Having high bilirubin levels can be dangerous and can lead to complications, especially in newborns. This can result in a condition known askernicterus,in whichseizures, irreversible brain damage, and death can occur.
What Causes High Bilirubin Levels?
Many conditions can lead to high bilirubin levels. There are two different types of hyperbilirubinemia comes in two main forms:
Causes of unconjugated high bilirubin levels include:
Causes of conjugated high bilirubin levels include:
What Medications Cause High Bilirubin?
Some drugs can impair liver function and cause high bilirubin levels. This can be due to underlying liver problems or the result of prolonged use or overuse.
These include:
Certain herbs and herbal remedies are known to be highly toxic to the liver.These include Chinese ginseng, comfrey, Jin Bu Huan, kava, kombucha tea, and sassafras.
Liver Damage from Medication (Drug-Induced Liver Disease)
What Causes High Bilirubin in Newborns?
Premature babies, babies who are small for gestational age, and twins are more likely to have high bilirubin levels. It’s also more common in breastfed babies.
Severe jaundice in babies can also be a sign of an underlying health condition, such as:
Hyperbilirubinemia can be diagnosed with a blood test. The test measures the level of total bilirubin (both conjugated and unconjugated) and direct (conjugated) bilirubin levels in the blood.
The indirect (unconjugated) bilirubin levels can be inferred from the total and direct bilirubin values. Although labs may use different reference ranges, there are generally accepted normal levels.
Bilirubin is often included as part of a panel of tests that evaluate liver function and enzymes, including:
Normal Bilirubin Levels
Normal bilirubin level ranges in adults and children older than seven days old are:
In newborns, an indirect (unconjugated) bilirubin level below 8.7 mg/dL within the first 48 hours of birth is considered normal.
Low bilirubin levels are usually nothing to be concerned about.
What Is a Dangerously High Bilirubin Level?In newborns, a bilirubin level above 25 mg/dL is considered dangerously high. This is because excess unconjugated bilirubin can cross the blood-brain barrier and harm developing brains.To prevent this, high bilirubin should be treated if above:First 48 hours: 15 mg/dLAfter 72 hours: 20 mg/dLIn adults, high bilirubin isn’t necessarily dangerous, but it can signal a dangerous health condition.
What Is a Dangerously High Bilirubin Level?
In newborns, a bilirubin level above 25 mg/dL is considered dangerously high. This is because excess unconjugated bilirubin can cross the blood-brain barrier and harm developing brains.To prevent this, high bilirubin should be treated if above:First 48 hours: 15 mg/dLAfter 72 hours: 20 mg/dLIn adults, high bilirubin isn’t necessarily dangerous, but it can signal a dangerous health condition.
In newborns, a bilirubin level above 25 mg/dL is considered dangerously high. This is because excess unconjugated bilirubin can cross the blood-brain barrier and harm developing brains.To prevent this, high bilirubin should be treated if above:
In adults, high bilirubin isn’t necessarily dangerous, but it can signal a dangerous health condition.
AST and ALT Liver Enzymes: Measures of Liver Function
Other Tests for High Bilirubin Levels
Additional tests may be ordered to pinpoint the underlying cause of the dysfunction, particularly in the presence of jaundice.
Bilirubin testing would typically be repeated to monitor your response to treatment or to track the progression or resolution of the disease.
Uses, Side Effects, and Procedure of a Bilirubin Test
Differential Diagnoses
If your bilirubin levels are high, your healthcare provider will need to identify the underlying cause. It is important to remember that hyperbilirubinemia is not a disease, but rather a characteristic of a disease.
To this end, your healthcare provider will classify the cause as follows:
Pre-Hepatic Causes
In addition to a panel of red blood cell tests, your healthcare provider may request a bone marrow biopsy if cancer or other serious diseases are suspected.
Hepatic Causes
A liver biopsy may be recommended if there is a possibility of liver cancer. Genetic testing may be used to distinguish between the differenttypes of viral hepatitisor to confirm genetic disorders likehemochromatosisor Gilbert’s syndrome.
Post-Hepatic Causes
There is no single test that can differentiate the underlying causes of hyperbilirubinemia. Your diagnosis is based on the results obtained from a combination of tests.
Hyperbilirubinemia Treatment
In adults, treatment for high bilirubin levels depends on the underlying cause. Treatment can include approaches such as stopping the use of a toxic drug, surgery, or long-term therapy.
These are a few treatment approaches:
Sometimes, hyperbilirubinemia may not require specific treatment. For example, symptoms of acute viral hepatitis typically go away on their own as the infection resolves. The same applies to Gilbert’s syndrome, which is not considered harmful and does not require treatment.
If you are experiencing any symptoms of liver impairment, speak with your healthcare provider before taking any medications.
Treatment for Hyperbilirubinemia in Newborns
Neonatal hyperbilirubinemia may not require treatment if the jaundice is mild. For moderate to severe cases, treatment may involve:
What Is Hepatology?
High bilirubin levels are common in newborns but can signal an underlying health problem in adults and children.
High bilirubin occurs in newborns because their body is not yet efficient at removing bilirubin. Treatments include light therapy, IV immunoglobulin, or a blood transfusion.
8 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Fargo MV, Grogan SP, Saguil A.Evaluation of jaundice in adults.Am Fam Physician.2017;95(3):164-168.National Organization for Rare Disorders.Gilbert syndrome.Abdualmjid RJ, Sergi C.Hepatotoxic botanicals - an evidence-based systematic review.J Pharm Pharm Sci.2013;16(3):376-404. doi:10.18433/j36g6xAmerican College of Gastroenterology.Neonatal jaundice.U.S. National Library of Medicine: MedlinePlus.Newborn jaundice.Lala V, Goyal A, Bansal P, et al.Liver Function Tests. [Updated 2020 Mar 27]. In:StatPearls[Internet]. Treasure Island (FL): StatPearls Publishing; 2020Taylor T, Wheatley M.Jaundice in the Emergency Department: Meeting the Challenges of Diagnosis and Treatment. EB Medicine. 2018.Subcommittee on Hyperbilirubinemia.Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation.Pediatrics. 2004;114(1):297-316. doi:10.1542/peds.114.1.297Additional ReadingPunnoose, A.; Schwartz, L.; and Golub, R.Neonatal Hyperbilirubinemia.JAMA.2012;307(19):2115. doi:10.1001/jama.2012.4070.Van Wagner, L. and Green, R.Evaluating Elevated Bilirubin Levels in Asymptomatic Adults.JAMA.2015;313(5):516-17. doi:10.1001/jama.2014.12835.
8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Fargo MV, Grogan SP, Saguil A.Evaluation of jaundice in adults.Am Fam Physician.2017;95(3):164-168.National Organization for Rare Disorders.Gilbert syndrome.Abdualmjid RJ, Sergi C.Hepatotoxic botanicals - an evidence-based systematic review.J Pharm Pharm Sci.2013;16(3):376-404. doi:10.18433/j36g6xAmerican College of Gastroenterology.Neonatal jaundice.U.S. National Library of Medicine: MedlinePlus.Newborn jaundice.Lala V, Goyal A, Bansal P, et al.Liver Function Tests. [Updated 2020 Mar 27]. In:StatPearls[Internet]. Treasure Island (FL): StatPearls Publishing; 2020Taylor T, Wheatley M.Jaundice in the Emergency Department: Meeting the Challenges of Diagnosis and Treatment. EB Medicine. 2018.Subcommittee on Hyperbilirubinemia.Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation.Pediatrics. 2004;114(1):297-316. doi:10.1542/peds.114.1.297Additional ReadingPunnoose, A.; Schwartz, L.; and Golub, R.Neonatal Hyperbilirubinemia.JAMA.2012;307(19):2115. doi:10.1001/jama.2012.4070.Van Wagner, L. and Green, R.Evaluating Elevated Bilirubin Levels in Asymptomatic Adults.JAMA.2015;313(5):516-17. doi:10.1001/jama.2014.12835.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Fargo MV, Grogan SP, Saguil A.Evaluation of jaundice in adults.Am Fam Physician.2017;95(3):164-168.National Organization for Rare Disorders.Gilbert syndrome.Abdualmjid RJ, Sergi C.Hepatotoxic botanicals - an evidence-based systematic review.J Pharm Pharm Sci.2013;16(3):376-404. doi:10.18433/j36g6xAmerican College of Gastroenterology.Neonatal jaundice.U.S. National Library of Medicine: MedlinePlus.Newborn jaundice.Lala V, Goyal A, Bansal P, et al.Liver Function Tests. [Updated 2020 Mar 27]. In:StatPearls[Internet]. Treasure Island (FL): StatPearls Publishing; 2020Taylor T, Wheatley M.Jaundice in the Emergency Department: Meeting the Challenges of Diagnosis and Treatment. EB Medicine. 2018.Subcommittee on Hyperbilirubinemia.Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation.Pediatrics. 2004;114(1):297-316. doi:10.1542/peds.114.1.297
Fargo MV, Grogan SP, Saguil A.Evaluation of jaundice in adults.Am Fam Physician.2017;95(3):164-168.
National Organization for Rare Disorders.Gilbert syndrome.
Abdualmjid RJ, Sergi C.Hepatotoxic botanicals - an evidence-based systematic review.J Pharm Pharm Sci.2013;16(3):376-404. doi:10.18433/j36g6x
American College of Gastroenterology.Neonatal jaundice.
U.S. National Library of Medicine: MedlinePlus.Newborn jaundice.
Lala V, Goyal A, Bansal P, et al.Liver Function Tests. [Updated 2020 Mar 27]. In:StatPearls[Internet]. Treasure Island (FL): StatPearls Publishing; 2020
Taylor T, Wheatley M.Jaundice in the Emergency Department: Meeting the Challenges of Diagnosis and Treatment. EB Medicine. 2018.
Subcommittee on Hyperbilirubinemia.Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation.Pediatrics. 2004;114(1):297-316. doi:10.1542/peds.114.1.297
Punnoose, A.; Schwartz, L.; and Golub, R.Neonatal Hyperbilirubinemia.JAMA.2012;307(19):2115. doi:10.1001/jama.2012.4070.Van Wagner, L. and Green, R.Evaluating Elevated Bilirubin Levels in Asymptomatic Adults.JAMA.2015;313(5):516-17. doi:10.1001/jama.2014.12835.
Punnoose, A.; Schwartz, L.; and Golub, R.Neonatal Hyperbilirubinemia.JAMA.2012;307(19):2115. doi:10.1001/jama.2012.4070.
Van Wagner, L. and Green, R.Evaluating Elevated Bilirubin Levels in Asymptomatic Adults.JAMA.2015;313(5):516-17. doi:10.1001/jama.2014.12835.
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