Why doesn't kernicterus occur in the adult?

[qweewq11]

Kernicterus is a severe problem in neonates due to hyperbilirubinemia. What I can't seem to find out is why it only affects neonates, but not adults. Hepatocellular disease coupled with hemolysis can generate blood bilirubin levels that are higher than the levels in neonates.

Anyone know why adults don't get kernicterus? 😕

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[cchoukal]

I think there are 2 reasons:

1) infants livers are less able to conjugate (and thus aid excretion of) bilirubin, so blood levels stay high.

2) perhaps more importantly, infants blood brain barriers are more permeable than those of adults. Bilirubin is more able to get into their brains. This permeability is lower when bilirubin is bound to albumin (cuz the 2 together can't cross). So you can imagine that as bilirubin increases beyond the saturation point of available albumin, it's free to cross.

Consider, also, that other things can compete for bilirubin on albumin. sulfonamides, certain fatty acids, etc. The presence of these things can also cause kernicterus.

So back to you original question, adults have tighter blood brain barriers, better livers, and higher albumin concentrations. That's my understanding, anyway.

 

[smf]

Originally posted by qweewq11
Kernicterus is a severe problem in neonates due to hyperbilirubinemia. What I can't seem to find out is why it only affects neonates, but not adults. Hepatocellular disease coupled with hemolysis can generate blood bilirubin levels that are higher than the levels in neonates.

Anyone know why adults don't get kernicterus? 😕

Do you not think hepatic encephalopathy is a serious entity?

 

[domd2004]

3 words.... Blood Brain Barrier. It's developed in the adult, not newborn.

 

[Sessamoid]

Originally posted by smf
Do you not think hepatic encephalopathy is a serious entity?

Do you think hepatic encephalopathy is caused by elevated billirubin? The exact mechanism of hepatic encephalopathy is still not clear IIRC. However, none of the likely theories involve bilirubin deposits in the brain.

 

[drish11]

Kernicterus do occur in adults, however, it is very rare and only a few reported cases have been published. So far in my research the adults afflicted with kernicterus were those of severe hepatic dysfunction accompanied by delayed treatment.

Neonates have an immature blood brain barrier as compared to adults and they are more susceptible to have the insoluble bilirubin pass through and deposit on the brain tissues. thereby receiving the neurotoxic effects.
Thank you for posting this question

 

[Anastomoses]

Yes, thank you for posting this very very very basic biochemistry/physio question.

 

[Priapism4tooLong]

Kernicterus is a severe problem in neonates due to hyperbilirubinemia. What I can't seem to find out is why it only affects neonates, but not adults. Hepatocellular disease coupled with hemolysis can generate blood bilirubin levels that are higher than the levels in neonates.

Anyone know why adults don't get kernicterus? 😕

yeah its because of a more mature BBB. Just for some extra advice, make sure you understand direct/indirect and indications for phototherapy or for exchange transfusions.


edit: this is all in assumption you are studying medicine lol

 

[GadRads]

Yes, thank you for posting this very very very basic biochemistry/physio question.

You must know everything.

 

[Anastomoses]

You must know everything.

actually i know very little, making it look even sillier that someone revives a 10 yr old thread to mind blowingly explain the most fundamental aspects of kernicterus.

 

[DermViser]

Kernicterus do occur in adults, however, it is very rare and only a few reported cases have been published. So far in my research the adults afflicted with kernicterus were those of severe hepatic dysfunction accompanied by delayed treatment.

Neonates have an immature blood brain barrier as compared to adults and they are more susceptible to have the insoluble bilirubin pass through and deposit on the brain tissues. thereby receiving the neurotoxic effects.
Thank you for posting this question

yeah its because of a more mature BBB. Just for some extra advice, make sure you understand direct/indirect and indications for phototherapy or for exchange transfusions.


edit: this is all in assumption you are studying medicine lol

It's been 11 years. I'm sure he/she has figured it out by now.

 

[Priapism4tooLong]

It's been 11 years. I'm sure he/she has figured it out by now.

Lmao I didn't even realize it was 11 years ago

 

[Microshaft]

haters gonna hate

 

[colbgw02]

Kernicterus do occur in adults, however, it is very rare and only a few reported cases have been published. So far in my research the adults afflicted with kernicterus were those of severe hepatic dysfunction accompanied by delayed treatment.

Neonates have an immature blood brain barrier as compared to adults and they are more susceptible to have the insoluble bilirubin pass through and deposit on the brain tissues. thereby receiving the neurotoxic effects.
Thank you for posting this question

Random necrobumps fascinate me, but this one is pretty transparent.

"I'm an MD/PhD student doing research on kernicterus. I really want people to know this, so I'm going to bump a decade old thread on SDN to talk about it. Did I mention I'm an MD/PhD student? Also, I have many many leather-bound books and my apartment smells of rich mahogany."

 

[Priapism4tooLong]

Random necrobumps fascinate me, but this one is pretty transparent.

"I'm an MD/PhD student doing research on kernicterus. I really want people to know this, so I'm going to bump a decade old thread on SDN to talk about it. Did I mention I'm an MD/PhD student? Also, I have many many leather-bound books and my apartment smells of rich mahogany."

Lol did he say he was an md/phd student though? I may have missed it

 

[colbgw02]

Only in his status. Just putting the whole puzzle together.

 

[Priapism4tooLong]

Only in his status. Just putting the whole puzzle together.

haha oh i didn't see that. You are so observant, oh you're an attending no wonder. You must be a genius.

 

[colbgw02]

haha oh i didn't see that. You are so observant, oh you're an attending no wonder. You must be a genius.

 

[Brain Bucket]

Random necrobumps fascinate me, but this one is pretty transparent.

"I'm an MD/PhD student doing research on kernicterus. I really want people to know this, so I'm going to bump a decade old thread on SDN to talk about it. Did I mention I'm an MD/PhD student? Also, I have many many leather-bound books and my apartment smells of rich mahogany."

I wasn't aware that mahogany smells? Especially since it's usually lacquered - it's quite soft and is easily scratched?

 

[colbgw02]

I wasn't aware that mahogany smells? Especially since it's usually lacquered - it's quite soft and is easily scratched?

It's a formidable scent...It stings the nostrils. In a good way.

 

[Anastomoses]

Random necrobumps fascinate me, but this one is pretty transparent.

"I'm an MD/PhD student doing research on kernicterus. I really want people to know this, so I'm going to bump a decade old thread on SDN to talk about it. Did I mention I'm an MD/PhD student? Also, I have many many leather-bound books and my apartment smells of rich mahogany."

That's precisely what annoyed me about this necrobump - minus the MD/Phd extrapolation. I don't mind necrobumps and I don't mind offering solid info...I clicked on it myself to say BBB, but the effort of this guy looking it up and then giving an answer already provided in the responses for a 10+ yo thread...irked me.

Also I like rich scents.

 

[Psai]

Hey guys this is something that I forgot about and now I will remember it for step 1

 

[dyspareunia]

I love first post necrobumps.

 

[Freddie Mercury]

I don't think I ever learned this in class (or Pathoma?) so I'm actually glad for the bump

 

[Anastomoses]

I don't think I ever learned this in class (or Pathoma?) so I'm actually glad for the bump

Alright. I'm not being mean...but did you ever hear of kernicterus? And if you have...what exactly did you learn about it? That's a genuine question.

 

[evilbooyaa]

Alright. I'm not being mean...but did you ever hear of kernicterus? And if you have...what exactly did you learn about it? That's a genuine question.

What I remember is that it is a disease of the neonate due to hyperbilirubinemia that causes severe CNS symptoms. The treatment for which is keeping infants at risk under a UV light to induce breakdown and excretion of the excess bilirubin. IIRC, we never discussed the possibility of kernicterus in adults.

I may have known more as a MS1, but at this point, that's all I remember.

 

[evilbooyaa]

But I bet you knew the reason hyperbilirubinemia has this damage in infants and not adults is because of the BBB. I remember the difference of what I knew in M1 and M2. I wasn't trying to be haughty. The difference of the BBB in infants is intrinsically what makes this a neonate problem and rare in adults.

Idk maybe? I never thought about adults having CNS symptoms due to that since hyperbilirubinemia in adults generally presents as jaundice +/- abdominal pain (due to blockage). Since it is not physiologic for adults to be jaundiced (unlike babies), it is generally noticed relatively quickly.

 

[gregoryhouse]

But I bet you knew the reason hyperbilirubinemia has this damage in infants and not adults is because of the BBB. I remember the difference of what I knew in M1 and M2. I wasn't trying to be haughty. The difference of the BBB in infants is intrinsically what makes this a neonate problem and rare in adults.

I think you need to calm down. Maybe some people learned about kernicterus before they learned about infant development and the idea of the BBB not being fully formed didn't cross their minds. I mean you were clearly trying to be haughty. Theres no reason to look down on someone for asking a question even if its a basic one.

From the way you posted, you made it seem like he asked the difference between a red blood cell and a white blood cell.

 

[Brain Bucket]

I think you need to calm down. Maybe some people learned about kernicterus before they learned about infant development and the idea of the BBB not being fully formed didn't cross their minds. I mean you were clearly trying to be haughty. Theres no reason to look down on someone for asking a question even if its a basic one.

From the way you posted, you made it seem like he asked the difference between a red blood cell and a white blood cell.

Dunno. There's no reason to mock him, since no one knows everything, but everytime I've read about kernicterus in infants, it's pretty much ALWAYS mentioned the BBB. In-fact, I don't remember a single resource that skips the association.

 

[Anastomoses]

I think you need to calm down. Maybe some people learned about kernicterus before they learned about infant development and the idea of the BBB not being fully formed didn't cross their minds. I mean you were clearly trying to be haughty. Theres no reason to look down on someone for asking a question even if its a basic one.

From the way you posted, you made it seem like he asked the difference between a red blood cell and a white blood cell.

First of all, the guy who actually came to revive this lame thread (which wasn't as lame the first time around - I can see why a Caribb student might have missed this...or not...I've no idea what they are being taught) was so he could tell some SUPER DUPER obvious thing that is like...mentioned already 4 times before him. So yeah, from my perspective it looked stupid and silly to thank him for the excellent question.

Dunno. There's no reason to mock him, since no one knows everything, but everytime I've read about kernicterus in infants, it's pretty much ALWAYS mentioned the BBB. In-fact, I don't remember a single resource that skips the association.

Finally!

And it's true that even obvious things might slip past us. A classmate with excellent scores actually turned to me puzzled at the beginning of second year and said "wait, you mean -itis means inflammation always?". Yeah, I stared at her for a few seconds. It happens.

 

[GadRads]

Dunno. There's no reason to mock him, since no one knows everything, but everytime I've read about kernicterus in infants, it's pretty much ALWAYS mentioned the BBB. In-fact, I don't remember a single resource that skips the association.

It still doesn't matter. I opened the thread to post about about the BB barrier but saw it was already answered, but I was still ticked off by the seemingly haughty response by Anastomoses. Such condescending attitude is repulsive and destroys dialogue and general education. There are seemingly obvious things we don't know. It is not as if the person asked an ultra-basic question. And for anyone with an investigative mind, you might appreciate the possiblity that we might later find that BB barrier may not be even correct. I have had people ask seemingly basic questions only to find out there was far deeper reasoning that the majority just glossed over.

Anastomoses should get over herself.

 

[NickNaylor]

If you are, in fact, an attending, I wish I could be your med student. Any attending who responds to forum posts with .jpgs is my kind of mentor.

 

[Trannie]

Kernicterus is a severe problem in neonates due to hyperbilirubinemia. What I can't seem to find out is why it only affects neonates, but not adults. Hepatocellular disease coupled with hemolysis can generate blood bilirubin levels that are higher than the levels in neonates.

Anyone know why adults don't get kernicterus? 😕

Hint: google the barrier of brain blood. One has it the other one doesnt

 

[Donald Juan]

Like most threads on SDN, this one has gotten off topic. I'll try to get it back.

Kernicterus is due to deposition of unconjugated bilirubin in the basal ganglia that can lead to severe neurologic defects and even death in the newborn human. It can be due to decreased levels of albumin (freeing up UCB to cross the BBB), congenital deficiencies of liver enzymes (i.e. Crigler-Najarr), and megaloblastic anemia from use of drugs like sulfonamides during periods of physiologic jaundice in the newborn among other things.

It seems that a lot of people here are confused about why this only occurs in neonates and not in adults that suffer from hyperbilirubinemia. There may be many factors at play, but it seems that the number one factor (especially for board questions) is that the BBB in the infant is not fully developed, allowing for increased passage of substances into the brain parenchyma. I've bolded that last part for the ones here who seem to not understand this concept.

Edit: BBB = Blood-Brain Barrier

 

[Anastomoses]

It still doesn't matter. I opened the thread to post about about the BB barrier but saw it was already answered, but I was still ticked off by the seemingly haughty response by Anastomoses. Such condescending attitude is repulsive and destroys dialogue and general education. There are seemingly obvious things we don't know. It is not as if the person asked an ultra-basic question. And for anyone with an investigative mind, you might appreciate the possiblity that we might later find that BB barrier may not be even correct. I have had people ask seemingly basic questions only to find out there was far deeper reasoning that the majority just glossed over.

Anastomoses should get over herself.

1. I don't have to get over myself. But let's not talk about me. Address my comments or my inaccuracies - don't bring in your personal issues and start in on what you don't like about my personality. You don't think the question was basic? Okay. I could be wrong. To me it was the equivalent of saying "what is kernicterus?".
2. neonate BBB junctions + neonate inability to conjugate bilirubin are currently the standard knowledge w/bluelight phototherapy to treat. What you could theoretically find out in 10 years really has no bearing on any of this, head in the clouds much?

Hint: google the barrier of brain blood. One has it the other one doesnt

You're an attending? Neonates and infants do have it. The capillary endothelial junctions are just not as tight, from what I understood?

 

[colbgw02]

If you are, in fact, an attending, I wish I could be your med student. Any attending who responds to forum posts with .jpgs is my kind of mentor.

Come on in. The water's warm.

I am, in fact, an attending. I have the I-love-me wall of framed diplomas, certificates, and licenses to prove it. However, if it helps, I'm highly immature; my wife can confirm.

 

[tco]

Come on in. The water's warm.

I am, in fact, an attending. I have the I-love-me wall of framed diplomas, certificates, and licenses to prove it. However, if it helps, I'm highly immature; my wife can confirm.

A radiology attending with a job, none the less...

*shuffles back to the radiology sub-forum*

 

[Cytarabine]

Permanent sandy vagina syndrome

 

[gregoryhouse]

First of all, the guy who actually came to revive this lame thread (which wasn't as lame the first time around - I can see why a Caribb student might have missed this...or not...I've no idea what they are being taught) was so he could tell some SUPER DUPER obvious thing that is like...mentioned already 4 times before him. So yeah, from my perspective it looked stupid and silly to thank him for the excellent question.


Finally!

And it's true that even obvious things might slip past us. A classmate with excellent scores actually turned to me puzzled at the beginning of second year and said "wait, you mean -itis means inflammation always?". Yeah, I stared at her for a few seconds. It happens.

My problem had nothing to do with your initial diss on the revival of this thread (this question could have been answered just as easy with google), although your responses often lack tact. The fact that someone came in and said they were grateful this thread was bumped because they didn't remember being taught this in class (or pathoma) and you tried to belittle them is what I had a problem with. I actually just opened my pathoma book to look in it since I was curious and it doesn't mention the BBB. So like I said maybe this person used pathoma and it wasn't covered in class and thats the only sources he used, or maybe he just forgot that he actually did learn it before because it happened a while ago (happens to me with certain things), but honestly whatever the case its quite obnoxious to look down on someone because they are grateful to learn something they didn't know before (or forgot) because you think its simple.

I am almost positive you and everyone here has asked a silly question before.

 

[Brain Bucket]

If you are, in fact, an attending, I wish I could be your med student. Any attending who responds to forum posts with .jpgs is my kind of mentor.

I have dibs.

Sent from my SM-N9005 using Tapatalk

 

[Priapism4tooLong]

Come on in. The water's warm.

I am, in fact, an attending. I have the I-love-me wall of framed diplomas, certificates, and licenses to prove it. However, if it helps, I'm highly immature; my wife can confirm.

Does your wife insult or tease you about going onto these forums? my fiancee teases me everyday about it. And she calls all you guys idiots. I defend you guys though don't worry.

 

[Priapism4tooLong]

Like most threads on SDN, this one has gotten off topic. I'll try to get it back.

Kernicterus is due to deposition of unconjugated bilirubin in the basal ganglia that can lead to severe neurologic defects and even death in the newborn human. It can be due to decreased levels of albumin (freeing up UCB to cross the BBB), congenital deficiencies of liver enzymes (i.e. Crigler-Najarr), and megaloblastic anemia from use of drugs like sulfonamides during periods of physiologic jaundice in the newborn among other things.

It seems that a lot of people here are confused about why this only occurs in neonates and not in adults that suffer from hyperbilirubinemia. There may be many factors at play, but it seems that the number one factor (especially for board questions) is that the BBB in the infant is not fully developed, allowing for increased passage of substances into the brain parenchyma. I've bolded that last part for the ones here who seem to not understand this concept.

Edit: BBB = Blood-Brain Barrier

thanks for the edit, i thought BBB stood for Big Booty B******

 

[colbgw02]

Does your wife insult or tease you about going onto these forums? my fiancee teases me everyday about it. And she calls all you guys idiots. I defend you guys though don't worry.

Nah. Beer and SDN are basically my only vices, so I think she knows it could be worse.

 

[NickNaylor]

Does your wife insult or tease you about going onto these forums? my fiancee teases me everyday about it. And she calls all you guys idiots. I defend you guys though don't worry.

I get a similar response from my own.


Sent from my iPhone using Tapatalk

 

[tco]

thanks for the edit, i thought BBB stood for Big Booty B******

I would have paid so much more attention during histology and neuro anatomy...

Sent from my SCH-I535 using Tapatalk

 

[Kahreek]

Do you think hepatic encephalopathy is caused by elevated billirubin? The exact mechanism of hepatic encephalopathy is still not clear IIRC. However, none of the likely theories involve bilirubin deposits in the brain.

but probably products from billibrubin breakdown such as amonia, maybe. no one knows

 

[evilbooyaa]

Oh boy. The discussion here is not the fact whether the BBB is fully developed in neonates (or if this is the mechanism). Some people either forgot it or didn't think to consider the effect of hyperbilirubinemia in adults (as opposed to neonates).

Everything on SDN turns into drama, jesus. The question's been answered as fully as possible, but I wonder how many omre people are gonna go, "erhmagerd, BBB in neonates is totally not the same guise, god are you even a medical student? do you even lift books, bro?"

 

[DermViser]

If you are, in fact, an attending, I wish I could be your med student. Any attending who responds to forum posts with .jpgs is my kind of mentor.

Any attending, like @colbgw02, that uses the "Watchu talkin' about Willis" face, must be an awesome attending.

 

[DermViser]

You're an attending? Neonates and infants do have it. The capillary endothelial junctions are just not as tight, from what I understood?

You're like a basic science super heroine.

 

[tco]

You're like a basic science super heroine.

This is, like, the third thread in two days that you've hit on her in her own language. When you gonna seal the deal, brah?