• jaundice
• bilirubin
• sepsis
• hepatitis
• gall stones

We read with interest the article describing the causes of obvious jaundice (serum bilirubin >120 μmol/l) in South West Wales (Gut 2001;48:409–13). The authors make the point that contrary to the perception of many doctors, viral hepatitis is an unusual cause of jaundice (two of 121 cases) while sepsis/shock is a relatively common cause (27 of 121 cases).

We have performed a retrospective assessment of 100 cases of jaundice identified on biochemical testing who had presented to the Accident and Emergency Department or had been admitted to the acute medical or surgical admission wards at Stobhill Hospital, Glasgow. Our survey therefore looked at acute admissions with jaundice while that of Whitehead et al also included established inpatients who developed jaundice (22 of 117 inpatient cases). We drew a lower cut off levelof serum bilirubin (>60 μmol/l) as above this level jaundice should be clinically detectable.

The causes of jaundice we identified differed significantly from those of Whitehead et al (fig 1⇓). The predominant cause in our series was alcoholic liver disease (ALD) which may reflect the catchment area of our hospital. Only two patients presenting with jaundice had a diagnosis of “shock/sepsis”. It should be noted that 20 of the 27 patients with “shock/sepsis” in the South West Wales series developed jaundice as inpatients. Rather than suggest “shock/sepsis” as a common reason for jaundice which is often overlooked, it might have been more accurate to …