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Clinical importance: Excretion of Indican in urine is taken as a rough index of intestinal putrefaction.

1.Clinically in intestinal obstruction due to putrefaction, and absorption of these products in carcinoma liver, cholera, thyphus, excretion of ethereal SO4 increases. In cholera and thypus, sufficient indican is excreted to cause urine to assume a bluish tinge on standing.

2. Bacterial decomposition of tryptophan in pus anywhere in the body in pathological conditions increase the excretion of indican.

Neutral Sulfur Fraction

Ranges from 0.08-0.16 gm/day. It is composed of heterogenous mixture of sulfur compounds. These include cystine, methionine, urochrome, thiosulfates, oxy-proteic acids, thiocyanates, bile acids and taurine and its derivatives.

Clinical significance: Increase – Urinary sulfur (neutral fraction) is increased in:

Inherited disorders like cystinuria, Homocystinuria.

2. Melanuria in melanoma

3. In obstractive jaundice – due to excretion of bile acids

4. In hepato cellular jaundice

5. Cyanide poisoning – as cyanide is converted to thiocyanates

6. In chloroform anaesthesia.

IV. Sodium (Na) and Potassium (K)

The kidney plays the vital role in regulation of excretion of Na and K.

Normal value: Daily urinary output approximates their intake in diet. Under usual dietary conditions, a normal healthy adult excretes in the urine about 3-5gms (130-215mEq) of Na; and 2-4gms (50-100mEq) of K daily. Na:K ratio = is approx 5:3

Clinical significance: 1. Fasting or inadequate protein in take, in excessive tissue protein catabolism, with liberation of Intra-cellular fluid components, results in an increase in urinary K and a change in Na:K ratio (in fasting, there is lack of NaCl intake). 2. Mineralo corticoid, aldosterance, increases the reabsorption of Na and excretion of K. In primary aldosteronism (Conn’s syndrome) the excretion of K will increase. 3. Effect of acidification of urine: K enters the urine from the plasma by glomerular filtration and also by active tubular secretion, the latter mechanism apparently competing withh that for urine acidification. The amount of K in urine is thus influenced by the requirement of urine acidification. K excretion will be increased if acidification is low e.g. in alkaline ash diet, and in alkalosis. K excretion will be dicreased if acidification is high eg in highly acid diet, and in acidosis. 4. Abnormal loss, through extrarenal channels of Na e.g in excessive sweating, diarrhoea etc, or of K (in diarrhoea) results in decreased urinary excretion of these elements.

V. Calcium and Magnesium

Ordinarily the greater proportions of Ca and Mg are excreted in the faces. Generally, the urinary excretion of Ca lies between 0.1gm (100mg) and 0.3gm (300mg) and of Mg between 0.1gm (100mg) and 0.2gm (200mg) per day. Absorption depends on reaction of the intestinal contents – increased alkalinity of intestinal contents causes precipitation of increased amounts of Ca and Mg phosphates which are lost in the faeces, with less being absorbed in blood and excreted in urine. Reverse occurs with increased acidity of intestinal contents.

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