Jaundice in the ICU

Gut, Liver & Pancreas · ICU Decoded chapter 60 · Locked — free with a referral

By Dr Javed Akhtar · Last reviewed 3 October 2026

Cited to ACG 2017 liver chemistries · Tokyo 2018 · ASGE 2021 cholangitis · CDC 2026.

Key points

Fractionate first: unconjugated (hemolysis, Gilbert, drugs) versus conjugated (sepsis-associated cholestasis, obstruction, TPN, hepatitis).
Sepsis cholestasis is common and can mark organ dysfunction; treat the infection, exclude obstruction/drug injury, and monitor bilirubin and synthetic function.
Rising conjugated + LFTs: ultrasound for obstruction; review TPN and drug list.
Isolated unconjugated bilirubin may reflect Gilbert syndrome after excluding hemolysis. Conjugated, rising or symptomatic hyperbilirubinemia still needs cause-directed assessment.

Investigations

First tests: Liver biochemistry, Full blood count, Sodium, potassium, bicarbonate, urea and creatinine, Hepatobiliary ultrasound.

Only if indicated: Blood cultures, MRCP / source-directed biliary imaging, Reticulocytes, LDH and haptoglobin, Targeted viral/autoimmune/drug assessment.

Repeat monitoring: Liver biochemistry.

Management pathways in this chapter

Evaluating and Managing Hyperbilirubinemia

Locked

The pathway step by step, with its decision points
Treatment orders with doses
Why and when to send each test

Open the full chapter in ICU Decoded

Free with a referral from any ICU Decoded member, or by applying with your medical registration. How access works.

← Acute Liver Failure · Cirrhosis Complications →

More in Gut, Liver & Pancreas

Part of ICU Decoded — open the interactive version.

ICU Decoded — original critical-care and internal-medicine pathways by Dr Javed Akhtar, each cited to a current guideline. For education and quick reference; verify every dose against local protocols before prescribing.

Open the app · Ward Pathways — 87 cases · ICU Decoded chapters · Aladin Chirag bedside tools

How to use · About · Medical disclaimer · Privacy · Contact