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Topic:Thyroid Hormones

Thyroid hormones in horses are biochemical substances produced by the thyroid gland, primarily including thyroxine (T4) and triiodothyronine (T3). These hormones are involved in regulating metabolism, growth, and development in equine species. They influence various physiological processes such as energy production, thermoregulation, and cardiovascular function. Abnormal levels of thyroid hormones can indicate thyroid dysfunction or other metabolic disorders in horses. This page compiles peer-reviewed research studies and scholarly articles that explore the synthesis, regulation, and clinical implications of thyroid hormones in equine health and disease.
Validation and clinical utility of a novel immunoradiometric assay exclusively for biologically active whole parathyroid hormone in the horse.
Equine veterinary journal    May 21, 2003   Volume 35, Issue 3 291-295 doi: 10.2746/042516403776148246
Estepa JC, Garfia B, Gao PR, Cantor T, Rodriguez M, Aguilera-Tejero E.Parathyroid hormone (PTH) plays a critical role in the regulation of mineral metabolism in mammals. Until recently, the standard method for PTH measurement has been the 2nd generation intact-PTH (I-PTH) assay. Current evidence indicates that the I-PTH assay binds to the PTH molecule and to an inactive N-terminally truncated PTH fragment that tends to accumulate in the blood of uraemic patients. Therefore, a new 3rd generation PTH assay that detects only the whole PTH molecule (W-PTH; cyclase-activating PTH [CAP]) has been developed. Objective: To validate this more specific W-PTH assay for mea...
Effects of propylthiouracil and bromocryptine on serum concentrations of thyrotrophin and thyroid hormones in normal female horses.
Equine veterinary journal    May 21, 2003   Volume 35, Issue 3 296-301 doi: 10.2746/042516403776148309
Johnson PJ, Messer NT, Ganjam VK, Thompson DL, Refsal KR, Loch WE, Ellersieck MR.There exists a need for better diagnostic tests to characterise thyroid disease in horses. Currently available diagnostic tests fail to differentiate between thyroid gland disorders and thyroid abnormalities resulting from pituitary or hypothalamic problems. Objective: To evaluate the effects of treatment with propylthiouracil (PTU) and bromocryptine (BROM) on serum concentrations of triiodothyronine (T3), thyroxine (T4), reverse T3 (rT3) and equine thyroid-stimulating hormone (e-TSH, thyrotrophin) in mature horses. Methods: Healthy mature horses were treated using either PTU or BROM for 28 da...
Serum thyroxine concentrations and pregnancy rates 15 to 16 days after ovulation in broodmares.
Journal of the American Veterinary Medical Association    April 12, 2003   Volume 220, Issue 1 64-66 doi: 10.2460/javma.2002.220.64
Gutierrez CV, Riddle WT, Bramlage LR.To determine whether serum thyroxine (T4) concentration was associated with pregnancy rates 15 to 16 days after ovulation in mares and to determine whether thyroid hormone supplementation would enhance fertility in mares. Methods: Cohort study. Methods: 329 clinically normal broodmares. Methods: Mares were examined 15 to 16 days after ovulation to determine whether they were pregnant; blood samples for determination of serum T4 concentration were collected at the same time. Sixty mares were receiving thyroid hormone supplementation prior to the study because of low serum T4 concentration (< 16...
Hysteresis and calcium set-point for the calcium parathyroid hormone relationship in healthy horses.
General and comparative endocrinology    February 28, 2003   Volume 130, Issue 3 279-288 doi: 10.1016/s0016-6480(02)00621-4
Toribio RE, Kohn CW, Sams RA, Capen CC, Rosol TJ.Abnormalities in calcium (Ca(2+)) homeostasis are reported in horses with several pathological conditions; however, there is little information on Ca(2+) regulation in horses. The objectives of the present study were to determine the Ca(2+) set-point in healthy horses, to determine whether the Ca(2+)/parathyroid hormone (PTH) response curves were characterized by hysteresis, and to determine if the order of experimentally induced hypocalcemia or hypercalcemia had an effect on PTH secretion. The Ca(2+) set-point and hysteresis were determined in 12 healthy horses by infusing Na(2)EDTA and calci...
Parathyroid hormone-related peptide and indian hedgehog expression patterns in naturally acquired equine osteochondrosis.
Journal of orthopaedic research : official publication of the Orthopaedic Research Society    December 11, 2002   Volume 20, Issue 6 1290-1297 doi: 10.1016/S0736-0266(02)00055-4
Semevolos SA, Brower-Toland BD, Bent SJ, Nixon AJ.Early changes in parathyroid hormone-related peptide (PTH-rP) and Indian hedgehog (Ihh) expression were examined in equine articular osteochondrosis (OC) as a model of a naturally acquired dyschondroplasia. Cartilage was harvested from OC-affected femoropatellar or scapulohumeral joints from immature horses and normal control horses of similar age. PTH-rP expression levels were assessed by semi-quantitative PCR, in situ hybridization, and immunohistochemistry. Ihh protein expression levels were assessed by immunohistochemistry. Elevated PTH-rP protein and mRNA expression were identified in the...
Metabolic and osmoregulatory function at low and high (3800 m) altitude.
Equine veterinary journal. Supplement    October 31, 2002   Issue 34 545-550 doi: 10.1111/j.2042-3306.2002.tb05480.x
Greene HM, Cogger EA, Miltenberger TL, Koch AK, Bray RE, Wickler SJ.Altitude evokes physiological adjustments that include not only respiratory and cardiovascular properties, but also metabolic function, renal and endocrine responses. The purpose of the present study was designed to expand our understanding of the physiological process involved with acclimatisation to high altitude in equids. The study examined temporal effects on metabolic and osmoregulatory function in horses (n = 6) at rest and postexercise at 3800 m. Animals were studied at 225 m (Pb = 743 mmHg) and during a 10 day stay at altitude (Pb = 487 mmHg). Rest samples were taken 90 min postprandi...
Responses of seasonally anovulatory mares to daily administration of thyrotropin-releasing hormone and(or) gonadotropin-releasing hormone analog.
Journal of animal science    February 8, 2002   Volume 80, Issue 1 208-213 doi: 10.2527/2002.801208x
Gentry LR, Thompson DL, Stelzer AM.Seventeen seasonally anovulatory light horse mares were treated daily, starting January 5 (d 1), for 28 d with GnRH analog (GnRH-A; 50 ng/kg BW) and(or) thyrotropin-releasing hormone (TRH; 5 microg/kg BW) in a 2 x 2 factorial arrangement of treatments to test the hypothesis that combined treatment may stimulate follicular growth and development. Ovaries were examined via ultrasonography and jugular blood samples were collected every 3 d. Frequent blood samples were collected after treatment injections on d 1, 2, 4, 7, 11, 16, and 22; on d 29, all mares received an i.v. mixture of GnRH, TRH, su...
Thyroid-stimulating hormone in adult euthyroid and hypothyroid horses.
Journal of veterinary internal medicine    February 2, 2002   Volume 16, Issue 1 109-115 doi: 10.1892/0891-6640(2002)016<0109:tshiae>2.3.co;2
Breuhaus BA.The purpose of this study was to validate a thyroid-stimulating hormone (TSH) assay in a model of equine hypothyroidism. Thyrotropin-releasing hormone (TRH) stimulation tests were performed in 12 healthy adult mares and geldings, aged 4 to greater than 20 years. before and during administration of the antithyroid drug propylthiouracil (PTU) for 6 weeks. Serum concentrations of equine TSH, total and free thyroxine (T4), and total and free triiodothyronine (T3) were measured. Before PTU administration, mean +/- standard deviation baseline concentrations of TSH were 0.40 +/- 0.29 ng/mL. TSH incre...
The role of nutritional therapy in the treatment of equine Cushing’s syndrome and laminitis.
Alternative medicine review : a journal of clinical therapeutic    October 10, 2001   Volume 6 Suppl S4-S16 
Harman J, Ward M.Equine Cushing's syndrome, a relatively common and complex condition, is difficult to treat with conventional medicine. Cushing's syndrome involves a hyperplasia or adenoma of the anterior pituitary gland. Biochemical alterations include increased endogenous cortisol, insulin resistance, elevated adrenocorticotrophic hormone, and decreased thyroid hormone levels. Symptoms include hirsutism with no loss of the winter coat in summer, refractory laminitis, weight problems (over- or underweight), polyuria/polydipsia (Pu/Pd), frequent infections, lowered immunity to intestinal parasites, decreased ...
Plasma ionized calcium and parathyroid hormone concentrations in horses after endurance rides.
Journal of the American Veterinary Medical Association    August 24, 2001   Volume 219, Issue 4 488-490 doi: 10.2460/javma.2001.219.488
Aguilera-Tejero E, Estepa JC, López I, Bas S, Garfia B, Rodríguez M.To evaluate changes in plasma ionized calcium (Ca2+) and parathyroid hormone (PTH) concentrations in horses competing in endurance rides. Methods: Longitudinal clinical study. Methods: 28 horses. Methods: Venous blood samples were obtained from horses before and after racing 80 km. Plasma pH and concentrations of Ca2+, PTH, inorganic phosphorus, albumin, lactate, and magnesium were measured. Results: Overall, a significant decrease in mean (+/- SD) plasma Ca2+ concentration (from 6.44 +/- 0.42 to 5.64 +/- 0.42 mg/dl) and a significant increase in plasma PTH concentration (from 49.9 +/- 30.1 to...
Congenital hypothyroidism in foals.
The Canadian veterinary journal = La revue veterinaire canadienne    June 27, 2001   Volume 42, Issue 6 418 
Allen A.No abstract available
Comparison of serum parathyroid hormone and ionized calcium and magnesium concentrations and fractional urinary clearance of calcium and phosphorus in healthy horses and horses with enterocolitis.
American journal of veterinary research    June 13, 2001   Volume 62, Issue 6 938-947 doi: 10.2460/ajvr.2001.62.938
Toribio RE, Kohn CW, Chew DJ, Sams RA, Rosol TJ.To evaluate calcium balance and parathyroid gland function in healthy horses and horses with enterocolitis and compare results of an immunochemiluminometric assay (ICMA) with those of an immunoradiometric assay (IRMA) for determination of serum intact parathyroid hormone (PTH) concentrations in horses. Methods: 64 horses with enterocolitis and 62 healthy horses. Methods: Blood and urine samples were collected for determination of serum total calcium, ionized calcium (Ca2+) and magnesium (Mg2+), phosphorus, BUN, total protein, creatinine, albumin, and PTH concentrations, venous blood gases, and...
Effect of short-term feed restriction and calorie source on hormonal and metabolic responses in geldings receiving a small meal.
Journal of animal science    January 2, 2001   Volume 78, Issue 12 3107-3113 doi: 10.2527/2000.78123107x
Powell DM, Lawrence LM, Fitzgerald BP, Danielsen K, Parker A, Siciliano P, Crum A.The metabolic effects of short-term feed restriction and dietary calorie source were studied in horses receiving high-roughage or high-concentrate diets. Four Thoroughbred geldings were assigned to four treatment groups in a 4 x 4 Latin square experiment. The four treatments were 1) a nutritionally adequate high-roughage ration (70% roughage, 30% concentrate; AHR), 2) a nutritionally adequate high-concentrate ration (40% roughage, 60% concentrate; AHC), 3) 70% of the intake of the AHR diet (RHR), and 4) 70% of the intake of the AHC diet (RHC). Diets AHR and AHC were designed to meet the calori...
Prolonged food restriction and mild exercise in Shetland ponies: effects on weight gain, thyroid hormone concentrations and muscle Na(+),K(+)-ATPase.
The Journal of endocrinology    October 31, 2000   Volume 167, Issue 2 321-329 doi: 10.1677/joe.0.1670321
Suwannachot P, Verkleij CB, Kocsis S, Enzerink E, Everts ME.We determined the effects of food supply and low-intensity training on growth, serum thyroid hormone levels and the Na(+),K(+)-pump concentration in equine skeletal muscle. Twenty-two Shetland ponies were subjected to two different feeding regimes for 2(1/2) years (11 ponies per group): food restriction (body condition score kept at 2) or ad libitum fed (body condition score kept at 8). Five ponies in each group underwent low-intensity training. Gluteus medius muscle and serum samples were obtained in April 1998. Subsequently, all ponies were fed ad libitum and the training programme was stopp...
Hemithyroidectomy in a horse with confirmed hyperthyroidism.
Journal of the American Veterinary Medical Association    October 6, 2000   Volume 217, Issue 7 1051-1009 doi: 10.2460/javma.2000.217.1051
Alberts MK, McCann JP, Woods PR.A 23-year-old Quarter Horse gelding was admitted to the hospital because of cachexia and hyperactive behavior of 1 year's duration. At admission the horse was severely emaciated, tachycardic with a grade V/VI diastolic murmur, pyrexic, polydipsic, enophthalmic, and alopecic. The right lobe of the thyroid gland was noticeably larger than typical. The horse was also hyperexcitable and had a ravenous appetite. A presumptive diagnosis of hyperthyroidism was made on the basis of clinical signs and high plasma thyroid hormone concentrations. Confirmation of the diagnosis was made on the basis of res...
Hormones, growth factors and other plasma variables in relation to osteochondrosis.
Equine veterinary journal. Supplement    September 22, 2000   Issue 31 45-54 doi: 10.1111/j.2042-3306.1999.tb05313.x
Sloet van Oldruitenborgh-Ooste , Mol JA, Barneveld A.Osteochondrosis (OC) is a multifactorial disorder with endocrinological dysfunction and mineral imbalance having a role in pathogenesis. The present study focused on a possible relationship between insulin-like growth factor I (IGF-I), insulin-like growth factor II (IGF-II), parathyroid hormone (PTH), 1,25-dihydroxy-vitamin D (1,25(OH)2D), cortisol, copper, zinc, calcium, ionised calcium, magnesium and phosphorus and 5 different postmortem and radiographical osteochondrosis scores of hock and stifle joints in foals age 0-11 months. Osteochondrosis-positive foals showed a significantly lower IG...
Serum parathyroid hormone and calcitonin levels in racehorses with fracture.
The Journal of veterinary medical science    May 24, 2000   Volume 62, Issue 4 361-365 doi: 10.1292/jvms.62.361
Chiba S, Kanematsu S, Murakami K, Satoh A, Asahina M, Numakunai S, Goryo M, Ohshima K, Okada K.Serum parathyroid hormone (PTH) and calcitonin (CT) levels in fractured racehorses were measured by radioimmunoassay. Racehorses with fracture of large bone such as the radius, third metacarpus, third carpus, digital bone or tibia, showed normal PTH level and elevated CT level in the serum. Serum PTH level was slightly higher in racehorses with sesamoid bone fracture compared to that of healthy racehorses, but not statistically significant. Moreover, serum CT level of racehorses with sesamoid bone fracture was significantly higher than that of healthy racehorses. Racehorses with sesamoid bone ...
Stimulation by iodide of H(2)O(2) generation in thyroid slices from several species.
American journal of physiology. Endocrinology and metabolism    April 6, 2000   Volume 278, Issue 4 E692-E699 doi: 10.1152/ajpendo.2000.278.4.E692
Corvilain B, Collyn L, van Sande J, Dumont JE.The regulation of thyroid metabolism by iodide involves numerous inhibitory effects. However, in unstimulated dog thyroid slices, a small inconstant stimulatory effect of iodide on H(2)O(2) generation is observed. The only other stimulatory effect reported with iodide is on [1-(14)C]glucose oxidation, i.e., on the pentose phosphate pathway. Because we have recently demonstrated that the pentose phosphate pathway is controlled by H(2)O(2) generation, we study here the effect of iodide on basal H(2)O(2) generation in thyroid slices from several species. Our data show that in sheep, pig, bovine, ...
Polycystic kidneys as a cause of chronic renal failure and secondary hypoparathyroidism in a horse.
Equine veterinary journal    April 1, 2000   Volume 32, Issue 2 167-169 doi: 10.2746/042516400777591552
Aguilera-Tejero E, Estepa JC, López I, Bas S, Rodríguez M.Secondary hyperparathyroidism is a well known complication of renal failure in man (Llach 1995), carnivores (Nagode and Chew1992) and rodents (Bover et al.1994). In these species, renal disease results in increased synthesis and secretion of parathyroid hormone (PTH) and parathyroid gland hyperplasia. There are 3 main factors involved in the development ofsecondary hyperparathyroidism: a) phosphate (P) retention, dueto reduced glomerular filtration rate; b) decrease in calcitriol(CTR) production, as a consequence of renal mass loss; and c...
Correlation of two nonradioactive immunoassays to a radioimmunoassay technique for thyroxine measurement in equine serum. Solter PF, Farner S.The purpose of this study was to compare 2 different nonradioactive assay methods with a conventional radioimmunoassay (RIA) measuring the concentration of serum thyroxine (T4) in horses. Serum was obtained from 85 adult standardbred horses. The T4 concentration of each sample was analyzed by RIA, chemiluminescent enzyme immunoassay (CEI), and homogeneous enzyme immunoassay (HEI). The correlation between the HEI method and RIA method was significantly greater (r = 0.89) than the correlation between the CEI and the reference method (r = 0.53). In addition, the precision of the HEI method was si...
Exertional rhabdomyolysis in quarter horses and thoroughbreds: one syndrome, multiple aetiologies.
Equine veterinary journal. Supplement    February 5, 2000   Issue 30 533-538 doi: 10.1111/j.2042-3306.1999.tb05279.x
Valberg SJ, Mickelson JR, Gallant EM, MacLeay JM, Lentz L, de la Corte F.The purpose of this study was to determine if chronic exertional rhabdomyolysis (ER) in Quarter Horses and Thoroughbreds represents one or several distinct myopathies. Eighteen Quarter Horses and 18 Thoroughbreds with ER were selected from cases presented to the Veterinary Hospital on the basis of a history of ER, assessment of muscle histopathology, and serum CK activity before and 4 h post exercise. In addition, 2 of 3 of the following parameters were evaluated: muscle glycogen concentrations, thyroid hormones (T3, T4), fractional excretion (FE) of sodium, potassium and chloride. The CK resp...
The effect of diet composition and feeding state on the response to exercise in feed-restricted horses.
Equine veterinary journal. Supplement    February 5, 2000   Issue 30 514-518 doi: 10.1111/j.2042-3306.1999.tb05276.x
Powell D, Lawrence LM, Brewster-Barnes T, Fitzgerald B, Warren LK, Rokuroda S, Parker A, Crum A.Eight Thoroughbred horses were used to determine the effects of long-term calorie restriction and diet composition on serum T4 and T3 concentrations and metabolic responses with exercise. Horses were randomly assigned to 2 treatment groups (n = 4): Group 1, horses were fed a calorie-restricted diet designed to have 70% of the calories from the roughage source (RHR); Group 2, horses were fed a calorie-restricted diet designed to have 70% of the calories from the concentrate source (RHC). Horses then completed 2 step-wise exercise tests; one following a 12 h fast and one 2 h after a meal of 2 kg...
Relationship between thyroid function and seasonal reproductive activity in mares.
Journal of reproduction and fertility. Supplement    January 1, 2000   Issue 56 163-172 
Huszenicza G, Nagy P, Juhász J, Kóródi P, Kulcsár M, Reiczigel J, Guillaume D, Rudas P, Solti L.The relationship between thyroid function and seasonal reproductive activity in mares was investigated by comparing plasma triiodothyronine and thyroxine concentrations in anoestrous mares and in mares with cyclic ovarian activity during the anovulatory season. In study 1, the diurnal changes in plasma triiodothyronine and thyroxine concentrations on a single day were compared in anoestrous and cyclic mares. The mean thyroxine concentrations were significantly higher (P < 0.001) in the cyclic mares than in the anoestrous mares, whereas mean triiodothyronine concentrations were similar in bo...
Response of newborn foals with thyroid musculoskeletal disease to adrenocorticotrophic hormone (ACTH).
Journal of reproduction and fertility. Supplement    January 1, 2000   Issue 56 709-715 
Card CE, Manning ST.Fetal maturation and equine parturition are not understood fully, although the adrenal and thyroid glands are thought to have regulatory roles. Thyroidectomized equine fetuses undergo prolonged gestation, and spontaneous diseases such as thyroid musculoskeletal disease and gestational fescue endophyte exposure are also associated with delayed parturition. Thyroid musculoskeletal disease is characterized by: histologically hyperplastic thyroid glands, chondro-osseous dysplasia and dysgenesis, angular limb deformity, low resting thyroxine and triiodothyronine concentrations, and lack of response...
Primary hypoparathyroidism in two horses.
Australian veterinary journal    September 24, 1999   Volume 77, Issue 8 504-508 doi: 10.1111/j.1751-0813.1999.tb12119.x
Hudson NP, Church DB, Trevena J, Nielsen IL, Major D, Hodgson DR.Two Thoroughbred horses were presented with various clinical signs which included sweating, agitation, muscle twitching and synchronous diaphragmatic flutter. These signs were associated with profound hypocalcaemia. A diagnosis of primary hypoparathyroidism was made on the basis of low serum ionised calcium concentration, hyperphosphataemia and markedly reduced serum immunoreactive parathyroid hormone concentrations in the presence of normal renal function. Treatment with a combination of intravenous calcium and subsequently oral calcium, magnesium and a vitamin D analogue (dihydrotachysterol)...
Effect of hypothyroidism on blood lipid concentrations in horses.
American journal of veterinary research    June 22, 1999   Volume 60, Issue 6 730-733 
Frank N, Sojka JE, Latour MA, McClure SR, Polazzi L.To measure and compare concentrations of selected blood lipids before and after thyroidectomy in horses. Methods: 5 healthy adult mares. Methods: Mares were confirmed to be euthyroid. Thyroidectomy was performed, and hypothyroidism was confirmed. Selected blood lipid variables were measured before hypothyroidism was induced and weekly for 4 weeks after induction. Plasma concentrations of very low-density lipoprotein (VLDL), low-density lipoprotein (LDL), serum triglyceride (TG), total cholesterol (TC), and nonesterified fatty acid (NEFA) were measured. The composition of VLDL and LDL also was ...
Hemodynamic effects of thyroidectomy in sedentary horses.
American journal of veterinary research    January 26, 1999   Volume 60, Issue 1 14-21 
Vischer CM, Foreman JH, Constable PD, Benson GJ, Kline KH, Freeman DE, Campbell KL, Grubb TL.To investigate hemodynamic effects of thyroidectomy in horses at rest. Methods: 6 healthy aged Quarter Horse mares. Methods: Horses were monitored for 5 months before and 4 weeks after thyroidectomy and for an additional 4 weeks after administration of thyroid hormone supplement (2.5 microg of thyroxine/kg of body weight, PO, q 12 h, and 0.6 microg of triiodothyronine/kg, PO, q 12 h). Responses to thyroid-stimulating hormone (TSH) were measured before and 4 weeks after thyroidectomy. Other variables monitored daily were resting rectal temperature (T), heart rate (HR), respiratory rate (RR), an...
Hyperthyroidism associated with a thyroid adenocarcinoma in a 21-year-old gelding.
Journal of veterinary internal medicine    December 19, 1998   Volume 12, Issue 6 475-477 doi: 10.1111/j.1939-1676.1998.tb02153.x
Ramirez S, McClure JJ, Moore RM, Wolfsheimer KJ, Gaunt SD, Mirza MH, Taylor W.No abstract available
Triiodothyronine (T3), insulin and characteristics of 5′-monodeiodinase (5′-MD) in mare’s milk from parturition to 21 days post-partum.
Reproduction, nutrition, development    August 11, 1998   Volume 38, Issue 3 235-244 doi: 10.1051/rnd:19980303
Slebodziński AB, Brzezińska-Slebodzińska E, Nowak J, Kowalska K.It is generally accepted that hormones and tissue growth factors are supplied from mother to neonate via mammary secretion. Among the protein hormones, insulin and prolactin are considered as the most important milk components for neonates. The significance of the thyroid hormones, namely triiodothyronine (T3) generated locally by 5'-monodeiodinase (5'-MD) in the mammary tissues, for the mammary gland itself and for suckling neonates is still under consideration. In the present study the activity of the 5'-MD and the concentrations of T3 and insulin in mare's colostrum and milk during the firs...
Deconditioning reduces mineral content of the third metacarpal bone in horses.
Journal of animal science    August 5, 1998   Volume 76, Issue 7 1875-1879 doi: 10.2527/1998.7671875x
Porr CA, Kronfeld DS, Lawrence LA, Pleasant RS, Harris PA.Diet and exercise are two management factors that affect bone density and strength. We proposed that bone density and calcium status would be affected by deconditioning for 12 wk and by dietary Ca concentration. Eleven highly conditioned Arabian horses were taken out of training and placed in stalls for 12 wk. Horses were walked on a mechanical walker in two 30-min sessions, 7 d/wk. Diets were designated CC (.36% Ca) and HC (.62% Ca). Data were collected every 21 d. Serum or plasma were analyzed for total and ionized Ca, parathyroid hormone, osteocalcin, hydroxyproline, electrolytes, and blood...
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