Q. My bilirubin level is elevated consistently since three months. Why?

Answered by
Dr. Bindiya Thakkar
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Jul 01, 2016 and last reviewed on: Nov 07, 2019

Hi doctor,

Three months back, I started feeling feverish, but thermometer readings were normal. I went to a doctor and he ran a series of tests. Everything came out fine, except mild hepatomegaly and elevated conjugated bilirubin.

My bilirubin is elevated consistently for the past three months (total: 1.3-1.4; conjugated: 0.7-0.9). Other liver enzymes are normal. Recently, I have started noticing foamy urine. But, 24-hour urine protein test was normal. I always feel feverish and my body is hot to touch, but I have no fever. Is it related to biliary obstruction? I learnt that pancreatic cancer is one of the leading causes of biliary obstruction.

Dr. Bindiya Thakkar

Diabetology Endocrinology


Welcome to icliniq.com.

I have gone through your laboratory reports (attachments removed to protect patient identity).

All values are excellent, except total bilirubin which is at upper normal level which could be due to fatty liver. I would suggest you to avoid fatty and spicy foods as well as avoid alcohol if you are taking. It can also be due to side effect of any medication if you are taking. Rest assured you do not have pancreatic cancer. Because, it presents with obstruction of bile duct, causing elevated alkaline phosphatase which is normal in your case.

It also presents with loss of appetite, significant weight loss, nausea, fatigue, and midepigastric pain or back pain. But, if you are doubtful, I would suggest you to carry out CT examination of your pancreas and carry out tumor markers such as CA 19-9 antigen which is positive in pancreatic cancer.

Foamy urine is usually associated with protein in the urine, but you do not have protein. Therefore, I suggest that the appearance of your urine may be due to rapid urination with a full bladder. This can cause the appearance of foam. Also, dehydration may be a factor. You do not always feel thirsty when dehydrated. Thirst is a late sign of dehydration.

Therefore, initially I suggest you to empty your bladder more frequently if possible and drink plenty of water to ensure good hydration. Feeling hot could be due to high metabolism rate of body. I would suggest you to get thyroid profile test done. As thyroid hormones can alter the basal metabolic rate (BMR) of the body. Drink plenty of fluids and keep yourself hydrated. Drink more water, coconut water and butter milk.

Revert back after the tests to an internal medicine physician online --> https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician

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Hello doctor,

Thanks for your detailed reply. My thyroid test was also normal. I do feel dry on my face and eyes along with above symptoms. Since past two months, I have stopped alcohol (I used to take beer three to four times a week for the past one year) and significantly cut down on carbohydrates and fatty food.

During these two months, I have also lost 4-5 kg weight (from 78 kg to 74 kg). Is this weight loss normal on account of cutting down calories and alcohol or something to be concerned about?

I also do not take any medication, except four months back, I had taken Cetirizine and Allegra for seasonal allergy. My vitamin D was deficient (15) and B12 was lower than normal (230) for which I have started supplement since 15 days.

Dr. Bindiya Thakkar

Diabetology Endocrinology


Welcome back to icliniq.com.

Your weight loss is obvious after cutting down on beer and fatty foods. Keep it maintained. Your ideal weight should be around 70 kg to 72 kg. Do not worry. Take a balanced diet and cover up all your vitamin D and vitamin B12 levels by taking supplements. Stay healthy and avoid stress.

For further information consult an internal medicine physician online --> https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician

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