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The first step to breaking this vicious cycle is identifying and eliminating the triggers that perpetuate this cycle, using a Root Cause approach

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Second, confirm you are drawing the correct number of units

The key point is that regain is gradual and can be mitigated with strategic interventions

Intestinal metabolism (not shown in above graphic): In the gut, bacterial enzymes deconjugate bilirubin and convert it into: Urobilinogen , which has several fates: Some is reabsorbed into the portal circulation ( enterohepatic circulation ) A small amount is excreted in urine as urobilin (yellow pigment) Most is converted to stercobilin and excreted in feces (brown pigment) Indirect hyperbilirubinemia Indirect (unconjugated) hyperbilirubinemia occurs when there is an excess of bilirubin in the bloodstream before it has been processed by the liver