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Severe bacterial infection can impair bile secretion and give rise to cholestasis. Although alkaline phosphatase elevation can be seen in sepsis-induced cholestasis, the most common abnormality is isolated hyperbilirubinemia. Other potential causes of cholestasis need to be excluded before the diagnosis of sepsis-related cholestasis can be made. In the presence of elevations in alkaline phosphatase, cholangitis as the cause of fever should be investigated.