A patient with liver disease has a decline in his previously elevated urobilinogen levels. The nurse realizes this finding could indicate
1. overhydration.
2. protein catabolism
3. gastrointestinal bleeding.
4. severe liver failure.
4
Rationale: Urobilinogen is measured as a sensitive test for hepatic damage. It may increase before serum bilirubin levels increase. In early hepatitis or mild liver cell damage, the urine urobilinogen level will increase despite an unchanged serum bilirubin level. However, with severe liver failure, the urine urobilinogen level may decrease because less bile will be produced. A drop in the urobilinogen level is not an indicator of overhydration, protein catabolism, or gastrointestinal bleeding.
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