Jaundice and positive nicotinic acid test (40/1700)

A young male whose sclera was noted to be yellow by his colleagues has a hx of taking OTC
drugs for some pain. Tests showed raised bilirubin, ALT and AST normal. The provocation test
with IV nicotinic acid is positive and produces further rise in the serum bilirubin levels. What is
the most likely dx?

a. Acute hepatitis
b. Drug hypersensitivity
c. Gilberts syndrome
d. Acute pancreatitis




















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answer: C

As a rule, Gilbert syndrome can be diagnosed by a thorough history and physical examination and confirmed by standard blood tests. Laboratory results include the following:

• Unconjugated hyperbilirubinemia noted on several occasions
• Normal results from a complete blood count (CBC), reticulocyte count, and blood smear
• Normal liver function test (LFT) results
• An absence of other disease processes

Specialized tests that have occasionally been used to confirm a diagnosis of Gilbert syndrome include the following:

• Fasting test
• Nicotinic acid test
• Phenobarbital test
• Radiolabeled chromium test
• Thin-layer chromatography
• Drug clearance test
• Polymerase chain reaction (PCR) assay
• Percutaneous liver biopsy - Very rarely performed