Bilirubin is produced by the liver, spleen, and bone marrow and is also a by-product of hemoglobin breakdown. Total bilirubin levels can be broken into direct bilirubin, which is excreted primarily via the intestinal tract, and indirect bilirubin, which circulates primarily in the bloodstream. Total bilirubin levels increase with any type of jaundice; direct and indirect bilirubin levels help differentiate the cause of jaundice.

Normal Lab Values for Bilirubin

  • Total bilirubin: 0.3 – 1.0 mg/dL
  • Direct bilirubin (conjugated): 0.0 to 0.2 mg/dL
  • Indirect bilirubin (unconjugated): 0.1 to 1 mg/dL
  • Critical level: > 12 mg/dL

Nursing Considerations

  • Instruct the client to eat a diet low in yellow foods, avoiding foods such as carrots, yams, yellow beans, and pumpkin, for 3 to 4 days before the blood is drawn.
  • Instruct the client to fast for 4 hours before the blood is drawn.
  • Note that results will be elevated with the ingestion of alcohol or the administration of morphine sulfate, theophylline, ascorbic acid (vitamin C), or acetylsalicylic acid (Aspirin).
  • Note that results are invalidated if the client has received a radioactive scan within 24 hours before the test.