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Cancer

Bilirubin in HCC

09/08/2009

Question:

My father has HCC and bilirubin is now 14(surprisingly enough the other liver functions, although out of normal range, are nowhere as bad as the bili count).

I wanted to know what bili level would effect him mentally (until now although very tired and fatigued he is completely lucid) and at what level would it be life threatening (I know there are many aspects that could be fatal but I am just asking regarding the bili level).

In addition I wanted to know if by the time he his fully bed ridden will he be still fully aware of the situation or will his mental capacity go first.

I know there is no exact answer but a any qualified and generally speaking answer would be a great help.

Thank you very much!

Answer:

There really is no bilirubin cutoff level where a person's mental capacity is impaired. As the bilirubin level rises, you'll probably notice increasing jaundice (yellowing of the skin and eyes) and more fatigue. An isolated elevation in the bilirubin level may not accurately predict the mental status since it can actually get quite high in a number of settings (for example, if the bile duct becomes obstructed). Laboratory values in combination with the bilirubin that are probably more predictive of the liver not working would be the albumin level, INR level, and creatinine level and also the sodium level. If these laboratory values together are worsening, I would expect the mental status to become worse as well.

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Response by:

Julia Gore Thornton, MD Julia Gore Thornton, MD
Assistant Professor of Medicine
School of Medicine
Case Western Reserve University