Elevated serum bile acids in a child with liver disease

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Clinical Problem:

Ira Shah
Medical Sciences Department, Pediatric Oncall, Mumbai, India

Address for Correspondence: Dr Ira Shah, 1, B Saguna, 271, B St Francis Road, Vile Parle {W}, Mumbai 400056, India.

A 2½ years old girl presented with generalized itching since 8 months of age. There was no history of jaundice. Her milestones were appropriate for age. On examination, weight was 9.4 kg, height was 81 cms, and she had dry excoriated skin with 9 cms hepatomegaly. Other systems were normal. Investigations showed bilirubin 1.6 mg, dl, SGOT - 41 IU, L, SGPT – 62 IU, L, GGTP – 20, total proteins 6.7 gm, dl, albumin 3.2 gm, dl, alkaline phosphatase 894 IU, L, prothrombin time 11.1 sec., partial thromboplastin time 31.7 sec, cholesterol = 190 mg, dl and serum bile acids of 152.4 µmol, L {Normal = 0 - 10 µmol, L}. Ultrasound abdomen showed mild hepatosplenomegaly with gall bladder sludge. Liver biopsy showed piecemeal necrosis with early cirrhosis and no bile stasis or bile duct proliferation. She was started on cholestyramine, diphenhydaramine, ursodeoxycholic acid to which she had mild relief.

How to interpret serum bile acids_?

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