mineral metabolism

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Slide 1: 

MINERAL METABOLISM Dr. V. SIVA PRABODH MD.

IRON : 

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

Slide 8: 

2. Hemosiderosis 3. Hemochromotosis

Slide 9: 

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

Slide 11: 

Normal Serum levels 9 -11 mg/dl

Slide 12: 

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 .

Slide 14: 

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

Slide 16: 

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.

Slide 17: 

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

Slide 18: 

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

Slide 19: 

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.

Slide 20: 

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)

Slide 21: 

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.

Slide 22: 

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

Slide 23: 

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

Slide 25: 

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

Slide 26: 

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

Slide 27: 

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.

Slide 37: 

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

Slide 38: 

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

Slide 43: 

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