The health care provider may instruct you to discontinue drugs that affect the test. Drugs that can increase bilirubin measurements include allopurinol, anabolic steroids, some antibiotics , antimalarials, azathioprine , chlorpropamide , cholinergics, codeine , diuretics , epinephrine, meperidine , methotrexate , methyldopa, MAO inhibitors , morphine, nicotinic acid , oral contraceptives , phenothiazines , quinidine , rifampin , salicylates, steroids, sulfonamides, and theophylline . Drugs that can decrease bilirubin measurements include barbiturates , caffeine , penicillin, and high-dose salicylates. The physical and psychological preparation you can provide for this or any test or procedure depends on your child's age, interests, previous experience, and level of trust. Afterward, there may be some throbbing .
Bilirubin metabolism begins with the breakdown of red blood cells by phagocytic cells.
Hemoglobin is broken down to heme and globin. Heme is converted to bilirubin, which is then carried by albumin in the blood to the liver. Total serum bilirubin equals direct bilirubin plus indirect bilirubin. Conjugated bilirubin is excreted into the bile by the liver and stored in the gall bladder or transferred directly to the small intestines. Bilirubin is further metabolized by bacteria in the intestines to urobilins, which contribute to the color of the feces.