29. Jaundice (icterus). Causes and differential diagnosis.

Page created on February 20, 2022. Last updated on March 3, 2022 at 13:24


For neonatal jaundice, see topic A9 in paeds 1.

The normal upper limit for total bilirubin depends on the age, from < 8 µmol/L for 3 months – 5 years of age to < 24 µmol/L for those older than 11. Subicterus usually becomes apparent at total bilirubin levels >30 – 50 µmol/L, with jaundice developing when the level reaches 250 – 300 µmol/L.

According to the department, direct hyperbilirubinaemia causes a jaundice which is more greenish than the jaundice in indirect hyperbilirubinaemia.

Differential diagnosis in children beyond the neonatal period

Pathomechanism Etiology Typical features
Haemolysis Inherited RBC disorders Anaemia, non-Caucasian ethnicity
Sepsis Fever, systemic symptoms
Autoimmune haemolytic anaemia Symptoms of haemolytic anaemia
Drugs (usually antibiotics) Just started new drug
Malaria Recent travel to tropics
Impaired bilirubin conjugation Gilbert syndrome Mild and transient jaundice, triggered by stress/illness
Hyperthyroidism Tachycardia, diarrhoea, weight loss
Wilson disease Kayser-Fleischer rings, neuropsychiatric symptoms
Inborn error of metabolism Hypoglycaemia, muscle pain, exercise intolerance, cardiomyopathy
Viral hepatitis Tender liver on palpation, risk factors for transmission
Paracetamol overdose Suicidality, mental health issues
Autoimmune hepatitis Other autoimmune disorders
Crigler-Najjar syndrome Rare, normal LFT

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