Clues in the Ooze: The Body’s Secretions and Excretions

“What’s the grossest thing you’ve ever seen?”

Everybody might hate that question, but there’s no doubt EMS professionals witness some unsavory scenarios. They see them, however, in ways different than civilians, noted Ed Racht, MD, chief medical officer for GMR, in his Thursday presentation at EMS World Expo, “Secretions and Excretions: What Our Bodies Can Tell Us.”

Understanding the fluids the body produces—both normally and abnormally—may provide important insight into patients’ underlying conditions. Pay attention to what comes out of us, Racht urged—it could carry critical clues.

Excretions are metabolic waste eliminated passively from the body. Secretions are materials moved from one part of the body to another in an active process of metabolism. Racht overviewed nine critical fluids encompassing both that may interest a savvy diagnostician.

1. Blood—The only time it’s normal to have blood outside the body is during menstruation. The average adult contains around six liters of the stuff, and its top functions are perfusion and transport/delivery. Its color is related to hemoglobin saturation; darker blood has reacted with oxygen.
2. Menstrual fluid—The average female has around 520 periods in her life. Their average volume is around 40 mL—just 2½ tablespoons—but can appear larger on pads and in water. Their color is related to hydration and the duration of blood in the uterus. Menstrual fluid contains uterine tissue, mucus, vaginal secretions, and about 50% blood. This reflects normal turnover of the uterine lining, so don’t dismiss changes. (Read more here).
3. Mucus—Mucus is critical. Lining the cells of the digestive, respiratory, urinary, and reproductive tracts and even the eyes and ears, its contents include antiseptic enzymes, antibodies, and mucins (proteins that protect epithelial cells). The body produces around a liter a day, with hydration having a major impact. Mucus is a major indicator of inflammation and infection—pay particular attention to the color of what’s coughed up or blown from the nose, Racht said: Clear is normal; yellow indicates a looming infection or virus; green suggests the immune system is fighting back; and red/brown/darker may contain dried blood.
4. Pus—Pus means the immune system is working. It contains white blood cells, proteins, and cellular, bacterial, and foreign-body debris. Pus needs to leave the body, or it can form an abscess. Its color indicates the intensity of the immune response.
5. Semen—Besides sperm, semen contains proteins and is high in fructose. It has alkaline secretions to neutralize vaginal acidity. Blood in semen is not normal but not generally an indicator of serious pathology. (Have that evaluated, though.)
6. Saliva—The average adult produces about a liter a day, peaking at meals. Saliva contains antibacterial enzymes, antibodies, and mucins. It is critical for taste, with digestive enzymes, predominantly starch. A lack of saliva, as when waking up, can cause halitosis.
7. Sweat—Perspiration is water with key electrolytes and has a main function of thermoregulation. Humans produce 0.1–8 liters a day from around three million sweat glands. Eccrine glands produce the most, while apocrine glands are more associated with odor.
8. Tears—Tears come from the lacrimal glands and drain to the nasal cavity. They lubricate and remove toxins and are associated with emotional expression. Around 30% of elderly patients have reduced tear production.
9. Urine—Pee is the platinum-level fluid, Racht said, a true window into the metabolic state. It eliminates toxins, excrete excesses, and controls osmolality. Fetal amniotic fluid is mainly urine.

Finishing with a nod beyond the liquid realm, Racht also noted the color of people’s solid waste—i.e., poop—is important. The Bristol Stool Chart has been developed to aid clinical assessment.

All of this is very personal to people at the best of times and can be especially embarrassing when problems happen, Racht concluded—but the body’s secretions and excretions have a lot of good information and are worth looking at and asking about.