Minerals Final
Minerals Final
Minerals Final
Hypercalcemia:
• Elevation in serum Ca level (normal 9-11 mg/dl)
is hypercalcemia.
• It is associated with hyperparathyroidism caused
by increased activity of parathyroid glands.
• Elevation in the urinary excretion of Ca and P,
often resulting in the formation of urinary calculi,
is also observed in these patients.
• The determination of ionized serum calcium
(elevated to 6-9mg/dl) is more useful for the
diagnosis of hyperparathyroidism.
Hypocalcemia:
• lt is characterized by a fall in the serum Ca to
below 7 mg/dl, causing tetany.
• It is mostly due to hypoparathyroidism.
• This may happen after an accidental surgical
removal of parathyroid glands or due to an
autoimmune disease.
Rickets:
• It is a disorder of defective calcification of bones.
• This may be due to a low levels of vitamin D in
the body or due to a dietary deficiency of Ca and
P- or both.
• An increase in the activity of alkaline phosphatase
is a characteristic feature of rickets.
Renal rickets (vitamin D resistant rickets):
• Renal rickets is associated with damage to renal
tissue, causing impairment in the synthesis of
calcitriol.
• Renal rickets can be treated by administration of
calcitriol.
Osteoporosis:
• Osteoporosis is characterized by deminera-
Iization of bone resulting in the progressive loss of
bone mass.
• An adult body contains about 1 kg phosphate.
• It is found in every cell of the body.
• Most of it (about 80%) occurs in combination
with Ca in the bones and teeth.
• About 10% of body P is found in muscles and
blood in association with proteins, carbohydrates
and lipids.
• The remaining 10% is widely distributed in
various chemical compounds such as 2,3 BPG,
ATP, GTP, Creatine phosphate etc.
Biochemical functions
1. Phosphorus is essential for the development of bones and
teeth.
2. It is required for the formation of high-energy phosphate
compounds e.g. ATP, GTP, creatine phosphate etc.
3. Required for the formation of phospholipids,
phosphoproteins and nucleic acids (DNA and RNA).
4. lt is an essential component of several nucleotide
coenzymes e.g. NAD+, NADP+,PLP, ADP, AMP.
5. Several proteins and enzymes are activated by
phosphorylation.
6. Phosphate buffer system is important for the maintenance
of pH in the blood (around 7.4) as well as in the cells.
RDA
• The ratio of Ca : P of 1:1 is recommended (i.e.
800 mg/day) for an adult.
• For infants, however, the ratio is around 2:1,
which is based on the ratio found in human
milk.
Absorption
• Phosphate absorption occurs from SI (jejunum)
1 . Calcitriol promotes phosphate uptake along with
calcium.
2. Absorption of phosphorus and calcium is
optimum when the dietary Ca:P is between 1:2
and 2:1.
3. Acidity favours while phytate decreases
phosphate uptake by intestinal cells.
Serum phosphate
• Serum contains about 3-4mg/dl.
• The phosphate level of the whole blood is
around 40 mg/dl.
• This is because the RBC and WBC have very
high content of phosphate.
• The serum phosphate may exist as free ions
(40%) or in a complex form (50%) with cations
such as Ca2+ , Mg2+ , Na+ , K+.
• About 10% of serum phosphate is bound to
proteins.
• The fasting serum phosphate levels are higher
than the PP.
• Following the ingestion of carbohydrate (glucose),
the phosphate from the serum is drawn by the
cells for metabolism (phosphorylation reactions).
Excretion:
• About 500 mg phosphate is excreted in urine per
day.
• The renal threshold is 2 mg/dl.
• The reabsorption of phosphate by renal tubules
is inhibited by PTH.
• PTH stimulates the kidney to excrete phosphate
while conserving calcium.
• This is a protective mechanism b/c the solubility
product of calcium phosphate in body fluids is
readily exceeded if the concentrations of both
ions are elevated.
• The concentrations of both calcium and
phosphate tend to vary inversely b/c of the PTH
effect upon the kidney.
• GH increases the renal tubular reabsorption of
phosphate.
• In chronic renal disease there is phosphate
retention b/c of impaired glomerular filtration
Hyperphosphatemia
• Advanced renal insufficiency
• True and Pseudohypoparathyroidism
• Hypervitaminosis D
• Hypersecretion of GH
Hypophosphatemia
• Hyperparathyroidism
• Rickets (Vit D deficiency)
• Steatorrhea
• Fanconi syndrome (Impaired tubular
reabsorption of phosphate)
• Prolonged ingestion of antacids containing
Mg(OH)2 or Al(OH)3 lowers the serum phosphate
b/c of precipitation of insoluble phosphates in
the GIT.
Disease states
1. Serum phosphate level is increased in
hypoparathyroidism.
It is decreased in hyperparathyroidism.
2. In severe renal diseases, serum phosphate
content is elevated causing acidosis.
3. Vitamin D deficient rickets is characterized by
decreased serum phosphate (1-2 mg/dl).
4. Renal rickets is associated with low serum
phosphate levels and increased ALP activity.
• The adult body contains about 20 g Mg2+, 70% of
which is found in bones in combination with
calcium and phosphorus.
• The remaining 30% occurs in the soft tissues and
body fluids.
Biochemical functions
1. Magnesium is required for the formation of
bones and teeth.
2. Mg2+ serves as a cofactor for several enzymes
requiring ATP e.g. HK, glucokinase, PFK,
adenylate cyclase.
3. Mg2+ is necessary for proper neuromuscular
function.
Low Mg2+ levels lead to neuromuscular
irritability.
Dietary Requirements
• Reduced Hemoglobin