Bilirubin is a byproduct of the breakdown of old blood cells by the liver, normally excreted through bile into the digestive tract. When the liver is unable to remove and excrete the appropriate amount of bilirubin, it builds up in the bloodstream and result in a condition known as hyperbilirubinemia. Hyperbilirubinemia is commonly known as jaundice in infants but may also occur in adults due to liver disorder or other diseases.
Changes in Urine
According to the Merck Manual, one of the first signs of hyperbilirubinemia is often darkening of the urine. As the liver is unable to remove liver from the bloodstream, it must be filtered by the kidneys and excreted into the urine. This causes the urine to darken from the normal yellow color to an amber color. As the condition progresses, the urine may become an even darker, tea-like color. Kidney damage may also result because of the increased work being done by the kidneys to remove bilirubin from the blood.
Changes in Stool
When bilirubin is excreted through the bile ducts into the gastrointestinal tract appropriately, it is largely responsible for the normal brown coloration of stool. When the liver is not able to excrete bilirubin into the gastrointestinal system, the stool color may fade to yellow and eventually to a much lighter, pale clay-type color.
Changes in Skin
As bilirubin levels build up in the bloodstream, the brown coloration of bilirubin may cause yellowing of the skin and whites of the eyes in a condition known as jaundice. Jaundice is most commonly seen in infants but can occur in adults with high bilirubin levels as well. Jaundice may take longer to develop than stool and urine changes and may not be noticed as easily as it often occurs over long periods of time with chronic liver disease. Some patients with hyperbilirubinemia may also develop itching of the skin, known as pruritis because of the accumulation of bile salts on the surface of the skin.
Fatigue
High bilirubin levels may affect mental functioning. Foggy thinking, drowsiness and dizziness may be signs of hyperbilirubinemia, as it is essentially toxic to brain functioning. If hyperbilirubinemia is not treated, the patient may eventually lapse into an unarousable state known as hepatic coma that may, in part, lead to death related to liver failure.
Gastrointestinal Disturbance
Nausea and vomiting are also signs of hyperbilirubinemia, particularly when accompanied by other symptoms. Other patients may experience generalized abdominal discomfort or diarrhea from inadequate digestion of food. A lack of appetite may accompany gastrointestinal complaints, and many adults with hyperbilirubinemia may experience weight loss related to lack of nutritional intake.
