This document provides information on analyzing the constituents found in normal and abnormal human urine. It lists the normal ranges for creatinine, uric acid, urea, and other electrolytes found in urine. It also describes various tests used to detect abnormalities in urine like glucose, ketones, proteins, and bile constituents. Physical characteristics of urine like color, clarity, odor and their clinical significance are explained. Factors affecting the preservation of urine specimens and how they change if not preserved properly are also summarized.
Abnormal constituents of urine
1. ABNORMAL CONSTITUENTS OF URINE
2. Introduction o Urine is an excretory product of the body o It is formed in the body o Urine examination helps in the dignosis of various disease Volume :the average output of urine is about 1.5Lt/day. urine volume may be increased in excess water intake ,diabetes and renal disease. urine volume may be decreased in sweating , dehydration and kidney damage o Physical characteristics of urine appearance :
billirubin production billirubin transport and metabolism, different laboratory methods of billirubin estimation ,normal and abnormal levels of billirubin, different classification and types of jaundice and liver diseses, liver functioning, enterohepatic circulation, billirubin production and degradation, benefits and diseases of abnormal level of billirubin
these clearance test plays an very important role in determining the functioning capacity and working status of kidney.
and we estimate how amount of compund is excreted in the urine and absorption too.
and i also attached the mathematical caluculation to identify the metabolic valuve of urea, creatinine, inulin clearance by kidney.
Abnormal constituents of urine
1. ABNORMAL CONSTITUENTS OF URINE
2. Introduction o Urine is an excretory product of the body o It is formed in the body o Urine examination helps in the dignosis of various disease Volume :the average output of urine is about 1.5Lt/day. urine volume may be increased in excess water intake ,diabetes and renal disease. urine volume may be decreased in sweating , dehydration and kidney damage o Physical characteristics of urine appearance :
billirubin production billirubin transport and metabolism, different laboratory methods of billirubin estimation ,normal and abnormal levels of billirubin, different classification and types of jaundice and liver diseses, liver functioning, enterohepatic circulation, billirubin production and degradation, benefits and diseases of abnormal level of billirubin
these clearance test plays an very important role in determining the functioning capacity and working status of kidney.
and we estimate how amount of compund is excreted in the urine and absorption too.
and i also attached the mathematical caluculation to identify the metabolic valuve of urea, creatinine, inulin clearance by kidney.
The liver is the largest organ in the body
It is located below the diaphragm in the right upper quadrant of the abdominal cavity and extended approximately from the right 5th rib to the lower border of the rib cage.
The liver is the largest organ in the body
It is located below the diaphragm in the right upper quadrant of the abdominal cavity and extended approximately from the right 5th rib to the lower border of the rib cage.
WHAT IS URINE ANALYSIS?
Urine analysis, also called Urinalysis – one of the oldest laboratory procedures in the practice of medicine.
Also knows as Urine- R&M (routine & microscopy)
Is an array of tests performed on urine
WHY URINALYSIS?
General evaluation of health
Diagnosis of disease or disorders of the kidneys or urinary tract
Diagnosis of other systemic disease that affect kidney function
Monitoring of patients with diabetes
Screening for drug abuse (eg. Sulfonamide or aminoglycosides)
COLLECTION OF URINE SPECIMENS
Improper collection---- may invalidate the results
Containers for collection of urine should be wide mouthed, clean and dry.
Analyzed within 2 hours of collection else requires refrigeration.
URINE CULTURE
Culture within 1 hour after collection or stored in a refrigerator at 4oC for no more than 18 hours.
Culture is performed when Polynephritis or Cystitis is suspected.
UTI is most frequent caused by E.Coli.
Other common agents are Enterobacter, Proteus, and Enterococcus faecalis.
URINALYSIS; WHAT TO LOOK FOR?
• Urinalysis consists of the following measurements:
Macroscopic or physical examination
Chemical examination
Microscopic examination of the sediment
Urine culture
PHYSICAL EXAMINATION OF URINE
Examination of physical characteristics:
Volume
Color
Odor
pH
Specific gravity
The refractometer or a reagent strip is used to measure specific gravity
PHYSICAL EXAMINATION
Normal- 1-2.5 L/day
Oliguria- Urine Output < 400ml/day
Dehydration
Shock
Acute glomerulonephritis
Renal Failure
Polyuria- Urine Output > 2.5 L/day
Increased water ingestion
Diabetes mellitus and insipidus.
Anuria- Urine output < 100ml/day
Seen in renal shut down Volume
PHYSICAL EXAMINATION
Normal
pale yellow in color due to pigments urochrome (different colour pigments in urine), urobilin (When urobilinogen- degraded product of bilirubin, is exposed to air, it is oxidized to urobilin, giving urine its yellow color) and uroerythrin (red pigment in urine).
Cloudiness
may be caused by excessive cellular material or protein, crystallization or precipitation of non pathological salts upon standing at room temperature or in the refrigerator.
Color
Colour of urine depending upon it’s constituents.
PHYSICAL EXAMINATION
Abnormal Colors:
Colorless – diabetes, diuretics.
Deep Yellow – concentrated urine, excess bile pigments, jaundice Color
Blue-Green – Methylene Blue, Pseudomonas (Bactrium), Riboflavin (Vitamin B2, in FAD give Yellow Orange Color)
Pink-Orange-Red – Hemoglobin, Myoglobin, Phenolphthalein, Porphyrins, Rifampicin (antibiotic against TB give orange color to urine)
Red-Brown-Black - Hemoglobin, Myoglobin, Red Blood Cells, Homogentisic acid (Homogentisic acid present in Blood and its oxidized form alkapton are excreted in the urine, giving it an unusually dark color), L-DOPA (Levodopa, is the most effective drug for Parkinson’s disease), Melanin (brown Pigment)
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
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2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
Biological screening of herbal drugs: Introduction and Need for
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Antifertility, Toxicity studies as per OECD guidelines
2. • Urine
– Water (95%) & Solids (5%)]
– Urinary out put: 1-1.5 L per day.
– Almost all substances found in urine are also find in
blood.
– may also contain cells, casts, crystals, mucus &
bacteria.
3. • Urine:
– Provides information about functioning &
abnormalities of kidneys & urinary tract
– Help in diagnosis of various systemic diseases [+nce
or –nce of several substances in urine]
5. • Preservation
– For routine analysis, urine is best examined fresh.
– Bacterial growth will ruin a specimen if analysis is
delayed for >3 hrs.
– Refrigeration: best way to preserve if analysis is
delayed.
• Refrigeration for >24hrs isn’t recommended.
10. Color:
• Normal urine is of amber color due to +nce of urochrome
(urobillin & urobilinogen) in urine.
• Colourless: Dilute urine
• Dark: Concentrated urine.
Colorless Dark
High fluid intake
Use of diuretic
DM
DI
Alcohol
Low fluid intake
Excessive sweating
Dehydration (burns, fever)
11. Abnormal colour of urine
11
Cloudy Excess PO4, Urates, Pus cells, Bacterial contamination
Red Frank Hematuria, hemoglobinuria, Myoglobinuria,
Intake of Pyridium, Phenolphthalein
Ingestion of Beet root, Black berries
Deep yellow Obstructive Jaundice, Ingestion of Vitamin B complex
Greenish Obst. Jaundice [excess Billirubin or billiverdin]
Phenol poisoning
Blue Methylene Blue poisoning
Brown black Hemorrhage in bleeding, Acidic urine, Porphyria
Black Alkaptonuria
Milky +nce of Chyle
Cola Nephritic syndrome
12. Clarity (Transparency)
• Normal urine clear or transparent
• Any turbidity will indicate +nce of either of the following:
• WBCs (pus).
• RBCs
• Epithelial cells
• Bacteria
• Casts
• Crystals
• Lymph
• Semen
• Phosphate
13. ODOR
Normal fresh urine Faint aromatic odor d/t +nce of volatile acids
Standing for long time Ammoniac odor
Bacterial action of pus (UTI) Offensive odor
Ketoacidosis Fruity odor
Phenylketonurea Mousy odor
14. VOLUME
Adult 600 – 2500 ml /24hr 0.5-1ml /kg/hr ~ 1.5L/24hr
Children 200–400ml/24hr 4ml/kg/ hr
Oligouria ↓ in urine flow [< 400 ml]
Polyuria ↑ in urine flow [> 2500 ml]
Anuria <100ml/day
Nocturia ↑ urination during night
15. • Causes of anuria:
• Severe Renal Defect
• Loss of urine formation mechanism.
• Due to +nce of stone or tumor.
• Post transfusion hemolytic reaction.
• Incompatibility between donor`s & receiver's blood
→ hemolysis → excess Hb causes blockage of
renal tubules → acute renal failure.
16. Causes of polyuria:
↑ed fluid intake
↑ed salt & protein intake
Addison’s disease
Intravenous saline or glucose
Chronic glomerulonephritis
Diuretics intake
Psychogenic polydipsia
DM
DI
Causes of Oliguria:
Water deprivation
Dehydration
Prolonged vomiting
Diarrohea
Excessive sweating
Acute renal failure
Hypotension
Renal Ischemia
Obstruction
[Calculi,Tumor, Prostatic hypertrophy]
17. • pH
– One of imp. functions of kidney is pH regulation.
– Blood pH: 7.4 & urine pH: ~ 6.0 (4.6 – 8.0)
[due to secretion of H+ & reabsorption of HCO3
-]
– Urine pH ≥ 9, indicate that urine is stand for a long
time & must be rejected.
Acidic urine Alkaline urine
Acidosis Alkalosis
DKA UTI [Proteus]
Starvation RTA
Dehydration Vegetarian diet
Diarrhea
E. coli infection
Muscular fatigue
18. Clinical significance of pH
1. Determine existence of acid base disorder.
2. Precipitation of crystals to from stone requires specific
pH for each type.
• Hence, pH control may inhibit formation of these
stones.
Crystals in acidic urine Crystals in alkaline urine
Ca oxalate Ca carbonate
Uric acid Ca phosphate
Mg Phosphate
19. Specific gravity
• Normal: 1.015-1.025.
• Theoretical extremes: 1.003 to 1.032.
• Contamination during collection & storage gives false value.
Sp. gravity is ↓ed in
•Excessive water intake
•DI
•Chronic glomerulonephritis
•All cases of polyuria [except DM]
Sp. gravity is ↑ed in
•DM [Glycosuria]
•Nephrosis [Albuminuria]
•All cases of oliguria
•Hematuria
•Hemoglobinuria
•Execessive sweating
20. • Low fixed specific gravity
– Due to loss of concentrating ability by damaged tubule,
sp. gravity of urine is fixed at 1.010.
– Found in:
• Chronic glomerulonephritis-end stage kidney
• ADH def.
• Polycystic kidney
• Chronic pyelonephritis
21. • Chemical examination of Urine
Sugar Blood Porphyrin
Protein Mucin 5-HIAA
KB Bile salt
Hb Bile pigment
22. • Urine examination for +nce of Sugar
– Glycosuria is defined as presence of sugar in urine in
a amount that can be detected by chemical methods.
– Reducing subst. found in urine:
Sugar Non-sugar
Glucose [DM, Endocrine disorder] CHCl3, Formaldehyde [preservative]
Lactose [Pregnancy, Lactation] Homogentistic acid
Fructose Ascorbic acid
24. • Alimentary Glycosuria
High glucose intake at once for > 1 week
↓
↓ed tolerance of body for glucose
↓
Glycosuria
25. Renal glycosuria
Defect in renal tubule
↓
Subsequent lowered renal threshold for glucose
↓
Glycosuria
• Occurs in:
– RTA
– Heavy metal poisoning
– Fanconi’s Syndrome
26. Benedict’s Test
• General test for Reducing sugars
• Reagent’s composition:
26
CuSO4 17.3gm Provide Cu++
Na2CO3 100gm Provide alkaline medium
Na-Citrate 173gm Cu++ chelating agent [slowly releases Cu++ ]
Dist. water 1000ml
27. Benedict’s Test
• Copper reduction test in alkaline medium
• Principle:
– Reducing sugars under alkaline medium, tautomerise
to form enediols (powerful reducing agent), which
reduces Cu++ to Cu+.
CuSO4 → Cu++ + SO4
--
Cu++ + Na-citrate → Cu-Na-citrate complex
Reducing sugar → Enediol
Enediol + Cu++ → Cu+ + sugar acids
Cu+ + OH- → CuOH
2 CuOH → Cu2O (↓)
27
28. • Procedure
– 5mL of Benedict’s reagent was taken in a test tube.
– 8 drops of urine was added.
– Mixed well.
– Boiled for 2 min
– Cooled & color was observed.
Observation Inference
Sample A
Sample B
29. Benedict’s Test
29
Blue color -ve
Green colour Trace < 0.5gm%
Green PPT + 0.5-1.0 gm%
Green to yellow PPT ++ 1.0 – 1.5 gm%
Yellow to red PPT +++ 1.5-2.0 gm%
Brick Red PPT ++++ >2.0 gm%
• Final color formed is dependent on amount of reducing
sugars +nt in given sample, thus benedict’s test is known
as Semi-quantitative test.
30. KETONURIA
• Usually found ketone bodies in human body & urine are:-
β-Hydroxy butyrate --Acetoacetate------ Acetone
[Primary]
• Normal level of ketone bodies in blood: 70mg/dl
• Renal threshold for ketone bodies: 1mg/dl
• normallly excreted in urine. [<20mg/day]
↑ed KB in urine
Intake of high fat & low carbohydrate diet
Starvation
Uncontrolled DM
Prolonged vomiting
31. • Rothera’s test [Nitroprusside test]
– Reagents:
(NH4)2SO4 Crystals Precipitate protein
NH3 solution Provide alkaline medium
Freshly prepared 5% Na-Nitroprusside solution
32. • Rothera’s test [Nitroprusside test]
– Principle: Saturation of urine with (NH4)2SO4 leads
to settling down of proteins as precipitate.
– KB remains at surface.
– In alkaline medium, KB reacts with sodium
Nitroprusside to give purple/pink ring (at interface).
33. • Rothera’s test [Nitroprusside test]
– Procedure:
– 2 mL of urine was taken in a test tube.
– 3 drops of nitroprusside solution was added to it.
– 2 mL of NH3 solution was added slowly along the
side wall of tube.
Observation Inference
Sample A
Sample B
34. Urinary protein (proteinuria)
• Tamm horse fall protein: protein normally found in urine
(<30 mg/24hr). [undetectable by routine methods]
• Proteinuria: defined as +nce of protein in urine that can be
detected by routine methods.
Pre renal Renal Post renal
Cardiac disease Glomerulonephritis Severe UTI
Fever Nephrotic syndrome Lesions of renal pelvis
Cancer Nephritic syndrome Lesions of bladder
Collagen disease Carcinoma of kidney Lesions of prostate
Intra-abdominal tomors Pyelonephritis Lesions of urethra
Rejection of kidney allograft
36. • Glomerular
– Causes:
a. Immune complex deposition
b. AGE deposition [Diabetic Nephropathy]
– ↑ in glomerular permeability due to: ↑ in pore size of
glomerular memb. & loss of -ve charges due to podocyte foot
process retraction & basement memb. damage.
– >3.5gm/24hr: hallmark for diagnosis of Nephrotic
syndrome
37. • Tubular
– Low mol. Wt. Proteins are normally filtered by
glomerulus & completely reabsorbed in PCT.
[eg: β2-microglobulin, Ig- light chains, & RBP]
Loss of tubular function
↓
↓ reabsorption
↓
Tubular proteinuria
– Causes: Toxic agents [Heavy metal, Drugs]
38. • Overflow:
– Caused by excess production of Ig light chains.
– Multiple myeloma or monoclonal gammopathy of
uncertain significance (MGUS)
39. Microalbuminuria
• Albuminuria: well-known predictor of poor renal function in
patients with type 2 DM & in essential HTN.
• Microalbuminuria: Urinary albumin 30 - 300 mg/24-hr urine.
• Overt Albuminuria (Macroalbuminuria)
– Urinary albumin excretion of ≥300 mg/24hr urine
• Urinary albuminuria comprises 20–70% or urinary total
protein excretion
40. • Bence Jones Protein
– Abnormal low mol. wt. globin consisting of light chains
of Ig (kappa or lamda).
– Characteristics feature:
• Precipitate at 40-60°C
• Precipitate dissolve at 100°C.
• Precipitate reappear on cooling
– Bence jones proteinuria occurs in Multiple myeloma.
41. Detection of proteinuria by Heat & acetic acid test
• Heat & acetic acid test:
– Principle: Native protein (Albumin) when heated at pI,
due to unfolding of quarternary, tertiary & secondary
structure gets denatured & thus precipitated.
– Phosphates in alkaline urine also gives similar results.
– Addition of acetic acid, confirms presence of protein if
white coagulum is formed.
42. • Procedure
– 2/3rd of test tube was filled with urine.
– Upper part of tube was heated.
– Observed & few drops of acetic acid was added.
Observation Inference
Sample A
Sample B
43. • Heller’s test
– Principle: Conc. HNO3 form acid meta protein in
reaction with protein to form precipitate at the interface.
– Procedure
• 3 mL of conc. HNO3 was taken in a test tube.
• 2 mL of urine was added along the side wall of tube.
Observation Inference
Sample A
Sample B
44. • Bile pigments found in urine
In Normal urine [< 0.02mg%] In abnormal urine
•Urochrome [Chemical nature unknown]
•Traces of urobilin [Small amount can’t
be detected]
•Bilirubin [in freshly voided urine]
•Urobilinogen
•Biliverdin [develops on standing urine
from oxidation of bilirubin]
•Urobilin [decomposition product of
bilirubin or urobilinogen due to action of
light or action of bacteria]
• Significance of bilirubinuria
– Only conjugated bilirubin appears in urine.
– It occurs with even minimal degree of jaundice &
may be detected before clinical jaundice is evident.
45. • Fouchet’s test
– Reagents:
• 10% BaCl2
• Fouchet’s reagent [FeCl3 in TCA]
– Principle:
• BaCl2 react with sulphate radicals in urine to form
BaSO4.
• Bile pigment gets adhered toBaSO4.
• Bilirubin (yellow) is oxidised to biliverdin (green)
with FeCl3 in presence of TCA.
46. • Fouchet’s test
– Procedure:
• 5 mL of urine was taken in a test tubr.
• 5 mL of BaCl2 & pinch of MgSO4 was added to it.
• Filter & dry the filter paper.
• Few drops of fouchet’s reagent was added to filter
paper & was dried.
Observation Inference
Sample A
Sample B
47. • Bile salts found in urine
– Na-taurocholate
– Na-glycocholate
• Bile salt appear in urine in obstructive jaundice.
48. Hay’s surface tension test [Sulphor test]
• Reagent:
– Sulphor powder
• Principle:
– Presence of bile salts ↓es surface tension of urine
allowing sulphor powder to sink.
False +ve hay’s test False -ve hay’s test
CHCl3 Thymol
Turpentine Excess urobilin in urine
49. Hay’s surface tension test [Sulphor test]
• Procedure:
– 4mL of urine was taken in a test tube.
– A pinch of sulphor powder was sprinkled on the
surface of urine.
Observation Inference
Sample A
Sample B
50. • Determination of bile pigment & bile salt in urine is useful
in differential diagnosis of Jaundice.
Pre Hepatic Hepatic Post Hepatic
Bile salt -nt +nt +nt
Bile pigment -nt Trace to 4+ 2+ to 4+
Urobilinogen 3+ to 4+ 2+ +nt/-nt
51. Benzidine test
• Capable of detecting even minute amount of blood.
• Detect free Hb/Mb.
• Glacial acetic acid:
– Ruptures RBC
– Act as solvent for Benzidine powder.
• Reagents‘:
– Saturated solution of benzidine
– 3% H2O2
52. Benzidine test
• Principle:
– Heme has peroxidase like property causing H2O2 to
release nascent oxygen that reacts with benzidine
solution to give greenish/ bluish color.
Faint green Trace
Green +
Greenish blue ++
Blue +++
Deep Blue ++++
53. Benzidine test
• Since urine is free of Hb & Mb.
– So, a positive test should be followed by exact cause
& origin of abnormal findings.
• Benzidine test is +ve in:
» Hematuria
» Hemoglobinuria
» Myoglobinuria
54. • Hematuria: > 10 intact RBC /HPF in urine
Renal Post renal General disease Disease of neighbouring
organ affecting kidney
Neoplasm Causes of ureter
Neoplasm
Calculus
Ureterocele
Malaria Carcinoma of vagina
TB of kidney Causes in bladder
Neoplasm
TB
Calculus
Purpura Carcinoma of uterus
Acute
glomerulonephritis
Causes of Prostate
Benign hyperplasia
Prostatic neoplasm
Prostatic TB
Scurvy Carcinoma of rectum
Nephritic
syndrome
Embolism of kidney
from SABE
Acute appendicitis
Pyelonephritis Hemophilia Acute inflammation of
fallopian tube
Pyonephrosis Malignant HTN of
kidney
56. • Myoglobinuria
Injury to cardiac/ skeletal muscle
↓
Mb released
↓
Excreted via urine
• Mb: toxic to kidney [high concentration may lead to Acute
renal failure.
MI
Infarction of large skeletal muscle
Muscle damage [Injury, Electric shock, Heat stroke]
Trauma
Editor's Notes
If pH is alkaline, turbidity may be observed due to precipitation of phosphates.
Such urine should be centrifuged before analysis.
Turbidity due to +nce of chylomicrons cann’t be centrifuged, but requires filtration using a special cellulose filter having <0.1 mm diameter.
This test is positive for Acetoacetate & acetone.
This test is negative for β-OH butyrate.
This test is positive for Acetoacetate & acetone.
This test is negative for β-OH butyrate.
This test is positive for Acetoacetate & acetone.
This test is negative for β-OH butyrate.