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    Ca MG Metabolism

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    justiceboakye
    1. Calcium and magnesium are important minerals in the body that help regulate many metabolic processes. Calcium makes up 1-2% of body weight and is important for bone formation, nerve transmission, muscle contraction, and hormone secretion. Magnesium is involved in over 300 enzyme reactions in the body. 2. Calcium is absorbed in the small intestine and regulated by parathyroid hormone, calcitonin, vitamin D, and other factors to maintain homeostasis. Hypocalcemia can result from hypoparathyroidism or hypercalcemia from primary hyperparathyroidism. 3. Magnesium is absorbed from the intestine and excreted mainly by the kidneys. Deficiency can cause neurom

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    Ca MG Metabolism

    Uploaded by

    justiceboakye
    27 views48 pages
    1. Calcium and magnesium are important minerals in the body that help regulate many metabolic processes. Calcium makes up 1-2% of body weight and is important for bone formation, nerve transmission, muscle contraction, and hormone secretion. Magnesium is involved in over 300 enzyme reactions in the body. 2. Calcium is absorbed in the small intestine and regulated by parathyroid hormone, calcitonin, vitamin D, and other factors to maintain homeostasis. Hypocalcemia can result from hypoparathyroidism or hypercalcemia from primary hyperparathyroidism. 3. Magnesium is absorbed from the intestine and excreted mainly by the kidneys. Deficiency can cause neurom

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    Ca Mg R

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    1. Calcium and magnesium are important minerals in the body that help regulate many metabolic processes. Calcium makes up 1-2% of body weight and is important for bone formation, nerve transmission, muscle contraction, and hormone secretion. Magnesium is involved in over 300 enzyme reactions in the body. 2. Calcium is absorbed in the small intestine and regulated by parathyroid hormone, calcitonin, vitamin D, and other factors to maintain homeostasis. Hypocalcemia can result from hypoparathyroidism or hypercalcemia from primary hyperparathyroidism. 3. Magnesium is absorbed from the intestine and excreted mainly by the kidneys. Deficiency can cause neurom

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    27 views48 pages

    Ca MG Metabolism

    Uploaded by

    justiceboakye
    1. Calcium and magnesium are important minerals in the body that help regulate many metabolic processes. Calcium makes up 1-2% of body weight and is important for bone formation, nerve transmission, muscle contraction, and hormone secretion. Magnesium is involved in over 300 enzyme reactions in the body. 2. Calcium is absorbed in the small intestine and regulated by parathyroid hormone, calcitonin, vitamin D, and other factors to maintain homeostasis. Hypocalcemia can result from hypoparathyroidism or hypercalcemia from primary hyperparathyroidism. 3. Magnesium is absorbed from the intestine and excreted mainly by the kidneys. Deficiency can cause neurom

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    Ca++ Mg

    1.

    ++

    Metabolism

    Synonyms: Blood Calcium, Ca, Total calcium Ionized calcium, Ca++ , Filterable calcium, Free calcium, Unbound calcium, Ionic calcium

    2.

    Mineral content: average 70 kilogram man

    Calcium Sodium
    Potassium Magnesium

    25.0mol 3.5 mol


    3.0 mol 1.0 mol

    1 kg 30 g
    120 g 24 g

    Plasma calcium components

    Calcium component Ionized calcium (Ca2+) Protein bound calcium Complexed calcium

    % Total plasma calcium 50-65 30-45 5-10

    Plasma calcium components

    The physiologically active component is plasma Ca2+

    Ca2+ controls the feedback mechanisms responsible for PTH secretion

    Calcium balance and requirements


    Balance: 0 in adults + in infancy and childhood in old age and in some disease states Requirements: Intake : 25 mmol (1g) / day Daily requirement : 0.5g / day

    Calcium requirements

    Late pregnancy and lactation: 2.0 g/day recommended Growing child: 1.0-1.5g/day Human breast milk contains 300 mg/L calcium

    Phosphorus

    Normal daily intake in adults: 1.5-3.0 g Minimum recommended intake: 1.0-1.5 g/day Defective absorption of calcium results in defective absorption of phosphorus as a result of precipitation of calcium phosphate in the gut

    Phosphate absorption

    Enhanced by vitamin D probably secondary to calcium Reduced by giving aluminium hydroxide due to precipitation of insoluble aluminium phosphate Plasma [phosphorus]: 0.8-1.4 mmol/L (from inorganic phosphate) Organic phosphorus is mostly derived from phospholipids and nucleic acids

    Plasma calcium and phosphate

    There is generally a reciprocal relationship between the two in plasma maintained through solution of bone salt: [Ca2+] x [phosphate] = 15 mg/dL [Calc.] x [phosphate] = 35 mg/dL Metastatic calcification when product > 70 mg/dL

    Composition of bone

    40% inorganic material 20% organic matrix 40% water Ca2+ bone ECF

    Bone formation

    Active osteoblasts synthesize and extrude collagen Collagen fibrils form arrays of an organic matrix called the osteoid. Calcium phosphate is deposited in the osteoid and becomes mineralized Mineralization involves deposition of 3Ca3 (P04)2 .Ca(OH)2 (hydroxyapatite).

    Bones cells

    Mineralization

    Requires adequate Calcium and phosphate Dependent on Vitamin D Alkaline phosphatase and osteocalcin play roles in bone formation Their plasma levels are indicators of osteoblast activity.

    Functions of calcium in the ECF


    Neuromuscular activity Membrane permeability Enzyme activity Hormone action Blood coagulaton

    Hormones involved with calcium metabolism


    Plasma calcium elevating Parathyroid hormone 1,25Dihydroxycholecalciferol (calcitriol) Plasma calcium lowering Calcitonin Katacalcin

    Parathyroid Hormone reference ranges

    (<0.8-8.5pmol/L)

    Parathyroid hormone (0-1g/L)


    Made up of 84 amino-acids Pre-pro PTH contains 115 aa 25 + 6 aa removed from the N terminal end of pre-pro PTH PTH Biological activity resides in N terminal 30 aa Principal fn is the control of ECF Ca2+

    PTH effect on the kidneys

    Promotes the release of cAMP in the kidneys Decreases the proximal tubular reabsorption of phosphate Reduces renal clearance of calcium

    Actions of parathyroid hormone

    Effect of PTH on glomerulus

    .thyroid gland structure

    Calcitonin and Katacalcin p CT:<0.1 g/L


    Produced by the C cells of the thyroid CT: 32 aa, KC: 21 aa Inhibit bone resorption Reduce hypercalcaemia towards normocalcaemia CT in pharmacological doses increases renal excretion of calcium and phosphate Marker for recurrence or metastasis of medullary carcinoma of the thyroid

    Formation of active vitamin D .

    calcitriol

    Pathways of vitamin D metabolism

    Actions of vitamin D

    Helps facilitated diffusion of calcium across intestinal mucosal cells by promoting synthesis of calcium binding protein in the intestines (1,25 / 24,25) Promotes the release of calcium from bone by osteoclasts (1,25)

    Summary of metabolism of calcium

    Plasma calcium (2.12-2.62 mmol/L) Ca2+ (1.12-1.23 mmol/L)


    PTH maintains the plasma Ca2+ constant Plasma albumin bound calcium changes with the change in [albumin] e.g. nephrotic syndrome malnutrition, pregnancy, protein losing enteropathy

    H+ effect on plasma calcium

    [H+] stronger binding of calcium to albumin [Ca2+] tetany A slow [H+] adjustment of [Ca2+] by PTH [H+] weaker binding of calcium to albumin (e.g. chronic renal failure, diabetic keto-acidosis, lactic acidosis)

    In chronic renal failure


    There is a decrease in plasma [calcium] Rapid correction of acidosis rapid [H+] stronger binding of ionized calcium tetany

    Metabolic bone disease1


    Osteoporosis: Results of all routine chemical tests are normal as a rule Urinary hydroxyproline There is loss of organic matrix and reduction in bone mass, seen on XR Deposition of calcium salts (mineralization) occurs normally, but the bone cannot maintain the same mass of mineral matrix

    Metabolic bone disease2


    Rickets and osteomalacia Failure of deposition of calcium salts in new bone Increased amount of osteoid or uncalcified matrix

    Metabolic bone disease3 Hyperparathyroidism


    Primary Parathyroid adenoma: (80-85% solitary adenoma) Parathyroid hyperplasia: (15-20% hyperplasia of all glands) Parathyroid carcinoma: (<0.5%)

    Hyperparathyroidism Presentation:.1

    Often asymptomatic Polyuria, polydipsia,weakness, tiredness Abdominal pain, pancreatitis Associated with MEN and ZE Associated with PUs, duodenal: gastric = 7:1 plasma [Ca2+] , PTH, PO43-* Renal calculi and nephrocalcinosis Metabolic bone disease

    Hyperparathyroidism Presentation:.2

    Excessive resorption of bone Proliferation of osteoclasts and replacement of bone by fibrous tissue. Bone cysts may form.

    Hyperparathyroidism
    Secondary Malnutrition/ malabsorption syndrome /vit D deficiency, 1-hydroxylase deficiency, renal failure plasma [Ca2+] PTH

    Hyperparathyroidism
    Tertiary Malnutrition/ malabsorption syndrome /vit D deficiency, 1-hydroxylase deficiency/ renal failure plasma [Ca2+] Hyperplasia/ adenoma of parathyroids PTH Autonomous PTH, / plasma [Ca2+]

    Causes of hypercalcaemia

    Artefact: Excessive venous stasis Parathyroid disease 1(MEN) and 3 Ectopic PTH production Bone disease: Cancer with osteolytic deposits, multiple myeloma, leukaemia, Pagets , Sarcoidosis Vitamin D intoxication Familial hypocalciuric hypercalcaemia

    Causes of hypocalcaemia

    Thyroid or parathyroid surgery If PO3-4 , chronic renal failure, hypoparathyroidism, pseudohypoparathyroidism, acute rhabdomyolysis (plasma [Ca2+] , PO43-, K+ ) If PO3-4 or , osteomalacia (ALP), overhydration or pancreatitis
    (Fat necrosis lipolysis saponification sequestration of Ca2+)

    Causes of hypocalcaemia

    Respiratory alkalosis: total calcium may be normal whereas Ca2+ may be depressed.

    Correction of plasma [calcium] using the plasma [albumin]


    Formula: (40-[albumin] x 0.02) + [calcium]

    [Calcium] in mmol/L (Plasma albumin Ref: 35-50g/L)

    Investigations to consider in hypercalcaemia


    Plasma [albumin] Plasma fasting [phosphate] Plasma [alkaline phosphatase] Plasma [urea] and [creatinine] Plasma [PTH] Plasma total [CO2] Urinary calcium excretion Urinary hydroxyproline

    Magnesium
    Second most abundant ICF cation Only a small fraction in the ECF 65% of the bodys magnesium in bone, 35% in cells Requirements Daily intake 10 mmol (250 mg) Significant quantities in gastric and biliary secretions

    Magnesium: absorption & excretion

    Absorbed from both small and large intestine Only a small amount is present in faeces Excretion is mainly urinary

    Magnesium: homeostasis

    Plasma magnesium is normally kept within narrow limits 1.7-2.4 mg/100 ml 35% of the Mg in plasma is protein bound Factors concerned with Mg metabolism are not yet defined Low [magnesium] tends to prevent PTH release and may cause hypocalcemia [Magnesium] tends to follow that of Ca+ &K+

    Magnesium: homeostasis

    There are specific Mg malabsorption syndromes Renal conservation mechanisms are very efficient Mg deficiency paraesthesia, fits, tetany, muscle weakness, cardiac arrhythmias Usually there is also K+ & Ca2+

    Causes of Magnesium deficiency plasma Mg 0.5 mmol/L


    Abnormal losses Prolonged GIT aspiration Diarrhoea Malabsorptive disease Alcohol Fistula Keto-acidosis Small bowel resection

    Causes of Magnesium deficiency plasma Mg 0.5 mmol/L


    Abnormal losses Renal disease: RTA & chronic pyelonephritis Extra-renal: diuretics, 1 & 2 aldosteronism Hyperparathyroidism

    Causes of Magnesium deficiency plasma Mg 0.5 mmol/L


    Reduced intake Kwashiorkor Marasmus

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