mineral metabolism

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Slide 1: 



IRON Total body content of Iron is 3-5 gm. 70% in Erythrocytes (in Hb) 5% in Myoglobin Remaining as other hemoproteins, like cytochromes, catalase, xanthine oxidase, tryptophan pyrollase, peroxidase etc. Non hemo proteins like transferrin, ferritin & Hemosiderin

Biochemical functions : 

Biochemical functions As imp. components of Hb & Mb helps in transport of O2 As imp. components of cytochromes & non heme substances helps in OXIDATIVE PHOSPHORYLATION Peroxidase – required for phagocytosis

Daily requirement : 

Daily requirement Adult - 10 mg/day Menstruating women - 18 mg/day Pregnant & Lactating mother – 20-40 mg/day Sources Rich Source – Liver, heart, kidney, spleen Good Sources: Spinach, bananas, apples, Egg yolk Poor Sources: Milk, wheat

Absorption : 

Absorption Iron is absorbed in Ferrous state. In food stuff Iron is present in Ferric form which is converted to Fe++ by Ascorbic acid or cysteine. Factors affecting Iron absorption Acidity, Ascorbic acid & cysteine levels High phosphate diet Phytic acid & Oxalates Cu deficiency

Normal Serum Iron level is 65 – 170 mg/100ml : 

Normal Serum Iron level is 65 – 170 mg/100ml Iron level in blood is maintained at the level of absorption only. It is not excreted in Urine. In Iron levels – Iron absorption In Iron levels – Iron absorption

Disorders : 

Disorders Iron deficiency anemia Defect in absorption Nutritional disorder Chronic blood loss Lead poisoning Hook worm Infestation Repeated Pregnancies Nephrosis

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2. Hemosiderosis 3. Hemochromotosis

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Major Elements: Daily requirement more than 100mg. - calcium, Magnesium, Phosphorus, Sodium, Potassium, Chlorine, Sulphur. Minor Elements: Daily requirement less than 100mg. - Iron, Iodine, Cu, Mn, Zn, Co, Mo, Se & F.

Calcium : 

Calcium Total content of Ca in our body is around 1 – 1.5 kg Sources:- Milk – Good source Egg Fish Medium source Vegetables Cereals - poor source Daily requirement:- Adults – 500mg Children – 1200 mg Pregnant & Lactating women – 1500 mg

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Normal Serum levels 9 -11 mg/dl

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Absorption: Ca absorption requires a carrier(calbindin) Factors increase Ca absorption Vitamin D (Calcitriol) Parathyroid hormone. Acidity Amino acids ( Lysine & Arginine) Factors decrease Ca absorption Phytic acid Oxalates High phosphate content Malabsorption syndromes.

Ca is mainly extracellular.Ca influx into the cell by Ca++/Na+ exchange expulsion by Ca++/H+ ATPase dependent pump. : 

Ca is mainly extracellular.Ca influx into the cell by Ca++/Na+ exchange expulsion by Ca++/H+ ATPase dependent pump. Functions Activation of Enzymes Calmodulin is a regulatory protein 4 Ca++ ions binds to calmodulin and activates it. Ex: 1) Glycogen synthase 2) glycerol – 3- phosphate dehydrogenase 4) Pyruvate dehydrogenase etc. Ca directly activates enzymes like Pancreatic lipase, enzymes in coagulation .

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2) Ca mediates excitation and contraction of Muscle fibres. Ca causes neuromuscular Irritability Tetany. 3) Ca helps in transmission of nerve impulses 4) Ca – Calmodulin complex regulates – Degranulation of Secretary Vescicles - Endocytosis - Cell motility

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5) Secretion of hormones 6) Act as second Messenger in Signal transduction 7) Decreases Vascular permeability 8) Ca is a factor in Coagulation 9) In Myocardium Ca++ prolongs systole 10) Bone & teeth

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Factors regulate Blood Ca levels Vit – D 2) PTH 3) Calcitonin 4) Phosphorus 5) Serum Protein 6) Alkalosis & Acidosis 7) Children & Pregnancy 8) Kidney threshold.

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PTH – acts on bones It induces osteoclasts Osteoclasts release Lactate – Solubulize & Collagenases Bone resorption Ca++

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PTH - acts on kidney PTH causes renal excretion of Ca renal excretion of Ph PTH induces formation of Calcitriol, this indirectly increases calcium absorption from Intestine

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Calcitonin Thyroid parafollicular cells. Decreases serum Ca levels Decreases the activity of osteoclasts Decreases resorption of bone Calcitonin secretion is stimulated by Serum Ca levels, gastrin, glucagon and biological amines.

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Serum Proteins : Hypo albunemia Serum Ca levels but ionized Ca level will be normal. Alkalosis - favor binding of Ca++ to proteins leading to Hypocalcemia Acidosis - favors Ionization of Ca++ Kidney threshold – Renal threshold for Calcium is 10 mg/dl (Ionized)

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Hypercalcemia Calcium levels more than 11mg/dl Major cause Hyper parathyrodism Parathyroid adenoma ectopic PTH Secreting tumor Osteoporosis X-rays show punched out lesions on bone. Urinary Calcium elevated Recurrent Urinary calculi Pancreatitis, myositis Anorexia, muscle weakness.

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Hypocalcemia Calcium levels less than 8.8 mg/dl. less then 7.5 mg/dl leads to Tetany. In tetany – Carpopedal spasm - Laryngismus

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Renal tubular acidosis Defect in production of H+ ions in Renal tubules. Excess urinary loss of Ca, bicarbonate, Sodium, potassium, mg & P.

Phosphorus : 

Phosphorus Total body content of phosphorus is 1kg It is an intracellular ion. Functions Formation of bone & teeth Production of high energy phosphates Synthesis of coenzymes NAD, NADP. DNA & RNA Synthesis Involved in Phosphorylation reactions Enzymes activation Regulates Acid Base balance

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Daily requirement 500 mg/day Sources Milk - good source Cereals, nuts & meat - moderate source Calcitriol Increases Phosphate absorption

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Normal levels 3 – 4 mg/dl in adults 5 – 6 mg/dl in children Hypo phosphatemia in Hyper parathyroidism Rickets.

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A reciprocal relation with Phosphorus and Calcium. In Renal failure – Phosphorus excretion diminished - Ca excretion Increase leading to low Ca levels and high phosphorus level Tetany

Magnesium : 

Magnesium Total body magnesium is 20 gm 75% in bones 25% in soft tissues & body fluids. Mainly seen in Intracellular fluid. Daily requirement Men - 400 mg/day Women- 300 mg/day Sources Cereals, beans, vegetables, milk & fruits Absorption requires a specific carrier in intestinal cells.

Normal Serum levels 1.8 – 2.2 mg/dl : 

Normal Serum levels 1.8 – 2.2 mg/dl Functions : Magnesium is the activator of enzymes requiring ATP. Mg++ is required for proper Neuromuscular function. Mg++ has a role in Insulin Sentivity Bone formation

Disorders : 

Disorders Hypo magnesemia Uncontrolled DM Chronic alcoholism Liver Cirrhosis Protein energy Malnutrition Neuromuscular – hyper irritability Cardiac arrhythmias Carpopedal Spasm

(Na+) Sodium : 

(Na+) Sodium Total body Sodium is 4000 meq 50% in bones, 40% in ECF & 10% in Soft tissues It is the major Extracellular cation Daily requirement 5-10 gm/day In Hypertensive 1 gm/day is recommended Sources Table salt (Nacl) is the major source. Other sources are vegetables, nuts, eggs and milk.

Functions : 

Functions Sodium regulates Osmotic pressure and fluid balance 2) Regulates Acid-base balance (NaH Co3) 3) It is involved in absorption of Glucose, Galactose & Aminoacids. 4) It helps in cell permeability.

Absorption : 

Absorption Sodium is readily absorbed in GIT Normal Serum level is 135-145 meq/L Excretion Kidney is the major source of excretion. Around 800 gm/day is filtered by Glomerulus in that 99% is reabsorbed by tubules. This reabsorbtion is controlled by Aldosterone Sweating causes loss of sodium.

Disorders : 

Disorders Hyponatremia Sodium levels. - Diarrhea, Vomiting - Chronic renal failure - Addisons disease (adreno cortical Insufficiency) - Renal tubular acidosis Mild - head ache, muscle cramps Moderate & severe - Low Blood pressure & Circulatory failure

Hypernatremia Sodium levels : 

Hypernatremia Sodium levels Cushings syndrome Prolonged administration of steroid hormones (Cortisone, ACTH/Sex hormones) Severe dehydration (only water) (Burns, Diabetes Insipidus) Increased Blood volume, HTN

Potassium : 

Potassium Total body potassium is 3500 meq 75% in skeletal muscle It is the major Intracellular cation Daily requirement 3-4 gm/day Sources Banana, Orange, Potato, beans, Liver etc. Rich Source is Tender coconut water.

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Functions: It maintains Intracellular Osmotic pressure Involves in cardiac & skeletal muscle activities Mainly K+ required in depolarization & contraction of Heart. Involved proper transmission of Nerve Impulses Pyruvate kinase needs K+ Involved in Biosynthesis of proteins

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Normal Serum Potassium 3.5 – 5 meq/L (Cell contain 100 – 120 meq/L) Excretion is through urine, during absorption of Na+ there is obligatory loss of K+ Aldosterone K+ excretion

Disorders : 

Disorders Hypo kalemia Serum K+ less than 3 meq/L Cushing syndrome Renal tubular acidosis Tubular necrosis Metabolic alkalosis Diarrhea & vomiting In Diabetic coma treatment with Insulin & Glucose Diuretics Muscle weakness Tachycardia Cardiac arrest

Hyperkalemia : 

Hyperkalemia Addisons disease Renal failure Increased hemolysis Tissue necrosis Metabolic acidosis Insulin deficiency Depression of central Nervous system Flacid paralysis Bradycardia & Cardiac arrest

Chlorine : 

Chlorine Intake, output & metabolism of Na+& cl- run in parallel Daily requirement 5-10gm Sources table salt – Nacl grains, leafy vegetables, eggs & Milk.

Excretion is through urine as sodium : 

Excretion is through urine as sodium Functions Regulates Acid Base balance, Osmotic pressure, fluid balance in relation with Na+ & k+ Cl- are necessary for HCL formation Chloride shift Salivary amylase is activated by chloride

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Normal serum level is 96-106 meq/L CSF level is 125 meq/L Disorders Hyper chloremia Dehydration Cushings syndrome Severe diarrhea Respiratory acidosis Renal tubular acidosis Hypo Chloremia Addisons disease Respiratory alkalosis Excessive vomiting

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