CALCIUM PHOSPHORUS - Aligarh Muslim UniversityOBJECTIVES By the end of this session you should be...
Transcript of CALCIUM PHOSPHORUS - Aligarh Muslim UniversityOBJECTIVES By the end of this session you should be...
![Page 1: CALCIUM PHOSPHORUS - Aligarh Muslim UniversityOBJECTIVES By the end of this session you should be able to: 1. Define principal elements & trace elements. 2. Enumerate the functions](https://reader036.fdocuments.in/reader036/viewer/2022081612/5f1578ae0e51132d74583bf7/html5/thumbnails/1.jpg)
CALCIUM & PHOSPHORUS DR. AKIF AHSAN Assistant Professor
Dept. of Biochemistry JNMC, AMU, Aligarh
![Page 2: CALCIUM PHOSPHORUS - Aligarh Muslim UniversityOBJECTIVES By the end of this session you should be able to: 1. Define principal elements & trace elements. 2. Enumerate the functions](https://reader036.fdocuments.in/reader036/viewer/2022081612/5f1578ae0e51132d74583bf7/html5/thumbnails/2.jpg)
OBJECTIVES By the end of this session you should be able to:
Define principal elements & trace elements. 1.
Enumerate the functions of Ca & P. 2.
Tell the normal levels of Ca & P in blood. 3.
Discuss the factors affecting the absorption of Ca.
4.
Discuss the role of Vit-D, PTH & Calcitonin in Ca-P homeostasis.
5.
![Page 3: CALCIUM PHOSPHORUS - Aligarh Muslim UniversityOBJECTIVES By the end of this session you should be able to: 1. Define principal elements & trace elements. 2. Enumerate the functions](https://reader036.fdocuments.in/reader036/viewer/2022081612/5f1578ae0e51132d74583bf7/html5/thumbnails/3.jpg)
Minerals
Required in relatively large quantities (>100 mg/day) - Principal elements or macronutrients
Required in minute quantities (<100 mg/day) - Trace elements or micronutrients
Ca, P, Mg, Na, K, Cl and S
Fe, I, Cu, Zn, Co, Mn, Mo, Cr, Se and F
![Page 4: CALCIUM PHOSPHORUS - Aligarh Muslim UniversityOBJECTIVES By the end of this session you should be able to: 1. Define principal elements & trace elements. 2. Enumerate the functions](https://reader036.fdocuments.in/reader036/viewer/2022081612/5f1578ae0e51132d74583bf7/html5/thumbnails/4.jpg)
CALCIUM
![Page 5: CALCIUM PHOSPHORUS - Aligarh Muslim UniversityOBJECTIVES By the end of this session you should be able to: 1. Define principal elements & trace elements. 2. Enumerate the functions](https://reader036.fdocuments.in/reader036/viewer/2022081612/5f1578ae0e51132d74583bf7/html5/thumbnails/5.jpg)
Calcium
Most abundant mineral in human beings.
Total Ca: 1000 grams » 99% is present in bones and teeth (Calcium phosphate)
![Page 6: CALCIUM PHOSPHORUS - Aligarh Muslim UniversityOBJECTIVES By the end of this session you should be able to: 1. Define principal elements & trace elements. 2. Enumerate the functions](https://reader036.fdocuments.in/reader036/viewer/2022081612/5f1578ae0e51132d74583bf7/html5/thumbnails/6.jpg)
Different forms of CALCIUM
Hydroxyapatite Ca10(PO4)6(OH)2
in Plasma
45% - free ionized form
45% - bound to proteins
10% - complexed with anions (citrate, sulfate, phosphate)
Typically measured in routine blood tests (9-11 mg/dL).
Physiologically active
![Page 7: CALCIUM PHOSPHORUS - Aligarh Muslim UniversityOBJECTIVES By the end of this session you should be able to: 1. Define principal elements & trace elements. 2. Enumerate the functions](https://reader036.fdocuments.in/reader036/viewer/2022081612/5f1578ae0e51132d74583bf7/html5/thumbnails/7.jpg)
Functions of Ca
Formation of bones & teeth
Nerve conduction
Neuromuscular transmission
Excitation & contraction of muscles
Coagulation of blood
Action of hormones
Activation of enzymes
![Page 8: CALCIUM PHOSPHORUS - Aligarh Muslim UniversityOBJECTIVES By the end of this session you should be able to: 1. Define principal elements & trace elements. 2. Enumerate the functions](https://reader036.fdocuments.in/reader036/viewer/2022081612/5f1578ae0e51132d74583bf7/html5/thumbnails/8.jpg)
Actin filaments
Synaptic vesicles containing Neurotransmitter molecules
Synapsin-I Reserve Pool
Ca2+
Calmodulin dependent kinase II
ATP
ADP P
Releasable Pool
Neurotransmitter molecules are released by exocytosis
![Page 9: CALCIUM PHOSPHORUS - Aligarh Muslim UniversityOBJECTIVES By the end of this session you should be able to: 1. Define principal elements & trace elements. 2. Enumerate the functions](https://reader036.fdocuments.in/reader036/viewer/2022081612/5f1578ae0e51132d74583bf7/html5/thumbnails/9.jpg)
Coagulation of Blood
Some clotting factors (II, VII, IX, and X) require Ca2+(Factor IV): » For their enzymatic action. » To bind with phospholipids (of platelets and
tissues).
Many of the anticoagulants used to prevent in vitro coagulation of blood (Oxalate, citrate & EDTA), act by binding Ca ions.
![Page 10: CALCIUM PHOSPHORUS - Aligarh Muslim UniversityOBJECTIVES By the end of this session you should be able to: 1. Define principal elements & trace elements. 2. Enumerate the functions](https://reader036.fdocuments.in/reader036/viewer/2022081612/5f1578ae0e51132d74583bf7/html5/thumbnails/10.jpg)
Action of Hormones
Ionized Ca acts as a second messenger for some of the hormones (Angiotensin, GnRH, TRH, oxytocin).
Moreover, the secretion of hormones which are stored in granular form also requires the presence of Ca ions (Insulin, calcitonin, vasopressin).
![Page 11: CALCIUM PHOSPHORUS - Aligarh Muslim UniversityOBJECTIVES By the end of this session you should be able to: 1. Define principal elements & trace elements. 2. Enumerate the functions](https://reader036.fdocuments.in/reader036/viewer/2022081612/5f1578ae0e51132d74583bf7/html5/thumbnails/11.jpg)
Activation of Enzymes
via Calmodulin » activates kinases
Direct activation » pancreatic lipase » enzymes of coagulation pathway
![Page 12: CALCIUM PHOSPHORUS - Aligarh Muslim UniversityOBJECTIVES By the end of this session you should be able to: 1. Define principal elements & trace elements. 2. Enumerate the functions](https://reader036.fdocuments.in/reader036/viewer/2022081612/5f1578ae0e51132d74583bf7/html5/thumbnails/12.jpg)
PHOSPHORUS
![Page 13: CALCIUM PHOSPHORUS - Aligarh Muslim UniversityOBJECTIVES By the end of this session you should be able to: 1. Define principal elements & trace elements. 2. Enumerate the functions](https://reader036.fdocuments.in/reader036/viewer/2022081612/5f1578ae0e51132d74583bf7/html5/thumbnails/13.jpg)
Phosphorus
Total P: 700 grams » 80% in bones & teeth » Remainder is distributed all over the body (nerves & muscles are particularly rich in P)
![Page 14: CALCIUM PHOSPHORUS - Aligarh Muslim UniversityOBJECTIVES By the end of this session you should be able to: 1. Define principal elements & trace elements. 2. Enumerate the functions](https://reader036.fdocuments.in/reader036/viewer/2022081612/5f1578ae0e51132d74583bf7/html5/thumbnails/14.jpg)
Different forms of PHOSPHATE
Hydroxyapatite Ca10(PO4)6(OH)2 in Plasma
Intracellular Phosphate (Phospholipids, DNA, RNA,
ATP, ADP)
Circulating Phospholipids
Inorganic Phosphates (HPO4
2- & H2PO4-)
Physiologically active and is typically measured in routine blood
tests (2.5-4 mg/dL)
![Page 15: CALCIUM PHOSPHORUS - Aligarh Muslim UniversityOBJECTIVES By the end of this session you should be able to: 1. Define principal elements & trace elements. 2. Enumerate the functions](https://reader036.fdocuments.in/reader036/viewer/2022081612/5f1578ae0e51132d74583bf7/html5/thumbnails/15.jpg)
Formation of bones & teeth
Formation of high energy compounds
Role in metabolism
Formation of nucleic acids
Formation of membranes
Formation of nervous tissues
Maintenance of pH
Functions of P
![Page 16: CALCIUM PHOSPHORUS - Aligarh Muslim UniversityOBJECTIVES By the end of this session you should be able to: 1. Define principal elements & trace elements. 2. Enumerate the functions](https://reader036.fdocuments.in/reader036/viewer/2022081612/5f1578ae0e51132d74583bf7/html5/thumbnails/16.jpg)
Role in Metabolism
P is a constituent of many co-enzymes: » FMN » FAD » NAD » NADP » Thiamine pyrophosphate » Pyridoxal phosphate » Coenzyme A
![Page 17: CALCIUM PHOSPHORUS - Aligarh Muslim UniversityOBJECTIVES By the end of this session you should be able to: 1. Define principal elements & trace elements. 2. Enumerate the functions](https://reader036.fdocuments.in/reader036/viewer/2022081612/5f1578ae0e51132d74583bf7/html5/thumbnails/17.jpg)
MCQ
a) Phosphorus b) Sulfur c) Magnesium d) Iron
Which is a trace element?
[KEY: d]
![Page 18: CALCIUM PHOSPHORUS - Aligarh Muslim UniversityOBJECTIVES By the end of this session you should be able to: 1. Define principal elements & trace elements. 2. Enumerate the functions](https://reader036.fdocuments.in/reader036/viewer/2022081612/5f1578ae0e51132d74583bf7/html5/thumbnails/18.jpg)
MCQ
a) Calcium phosphate b) Free ionized calcium c) Calcium bound to albumin d) Calcium bound to citrate
Which form of calcium is physiologically active?
[KEY: b]
![Page 19: CALCIUM PHOSPHORUS - Aligarh Muslim UniversityOBJECTIVES By the end of this session you should be able to: 1. Define principal elements & trace elements. 2. Enumerate the functions](https://reader036.fdocuments.in/reader036/viewer/2022081612/5f1578ae0e51132d74583bf7/html5/thumbnails/19.jpg)
MCQ
a) Insulin b) Angiotensin c) GnRH d) Oxytocin
Ca2+ acts as a second messenger for all the following hormones, except:
[KEY: a]
![Page 20: CALCIUM PHOSPHORUS - Aligarh Muslim UniversityOBJECTIVES By the end of this session you should be able to: 1. Define principal elements & trace elements. 2. Enumerate the functions](https://reader036.fdocuments.in/reader036/viewer/2022081612/5f1578ae0e51132d74583bf7/html5/thumbnails/20.jpg)
MCQ
a) Cycline b) Calmodulin c) Collagen d) Kinesin
A small Ca binding protein that modifies the activity of many enzymes and other proteins in response to
changes of Ca2+ concentration, is known as:
[KEY: b]
![Page 21: CALCIUM PHOSPHORUS - Aligarh Muslim UniversityOBJECTIVES By the end of this session you should be able to: 1. Define principal elements & trace elements. 2. Enumerate the functions](https://reader036.fdocuments.in/reader036/viewer/2022081612/5f1578ae0e51132d74583bf7/html5/thumbnails/21.jpg)
ABSORPTION of Calcium
and Phosphorus
![Page 22: CALCIUM PHOSPHORUS - Aligarh Muslim UniversityOBJECTIVES By the end of this session you should be able to: 1. Define principal elements & trace elements. 2. Enumerate the functions](https://reader036.fdocuments.in/reader036/viewer/2022081612/5f1578ae0e51132d74583bf7/html5/thumbnails/22.jpg)
Absorption of Ca
Absorption of Ca occurs by an active uptake system in the upper part of small intestine. » 10-20% of the dietary Ca is absorbed.
Ca absorption is affected by: » pH » Calcium : Phosphorus ratio » Proteins » Vitamin-D & Paratharmone
![Page 23: CALCIUM PHOSPHORUS - Aligarh Muslim UniversityOBJECTIVES By the end of this session you should be able to: 1. Define principal elements & trace elements. 2. Enumerate the functions](https://reader036.fdocuments.in/reader036/viewer/2022081612/5f1578ae0e51132d74583bf7/html5/thumbnails/23.jpg)
Vit-D & PTH
Active form of Vit-D: Calcitriol » Vit-D is converted into its active form with the help of PTH.
Calcitriol acts on intestinal mucosa and induces the synthesis of: » Ca-binding protein (Calbindin) » Ca-dependent ATPase » Alkaline phosphatase
These are required for the active absorption of Ca.
![Page 24: CALCIUM PHOSPHORUS - Aligarh Muslim UniversityOBJECTIVES By the end of this session you should be able to: 1. Define principal elements & trace elements. 2. Enumerate the functions](https://reader036.fdocuments.in/reader036/viewer/2022081612/5f1578ae0e51132d74583bf7/html5/thumbnails/24.jpg)
Cholecalciferol Calcidiol
Calcitriol
Liver
Kidney Hydroxylase Hydroxylase
Ca-binding protein Ca-dependent ATPase Alklaline phosphatase
Calcium absorption
Int. mucosa
Int. mucosa
Plasma Ca
Parathyroid gland
PTH
Released into circulation
Induction
![Page 25: CALCIUM PHOSPHORUS - Aligarh Muslim UniversityOBJECTIVES By the end of this session you should be able to: 1. Define principal elements & trace elements. 2. Enumerate the functions](https://reader036.fdocuments.in/reader036/viewer/2022081612/5f1578ae0e51132d74583bf7/html5/thumbnails/25.jpg)
pH
A relatively low pH increases solubility of Ca salts. » This increases Ca absorption.
Proteins
Presence of proteins and amino-acids (lysine & arginine) in the food facilitates the absorption of Ca.
![Page 26: CALCIUM PHOSPHORUS - Aligarh Muslim UniversityOBJECTIVES By the end of this session you should be able to: 1. Define principal elements & trace elements. 2. Enumerate the functions](https://reader036.fdocuments.in/reader036/viewer/2022081612/5f1578ae0e51132d74583bf7/html5/thumbnails/26.jpg)
Calcium : Phosphorus Ratio
Oxalic acid, phytic acid and malabsorption syndrome decreases Ca absorption.
The ideal ratio is 1:1 but the absorption may occur satisfactorily as long as the ratio lies between 1:2 and 2:1.
![Page 27: CALCIUM PHOSPHORUS - Aligarh Muslim UniversityOBJECTIVES By the end of this session you should be able to: 1. Define principal elements & trace elements. 2. Enumerate the functions](https://reader036.fdocuments.in/reader036/viewer/2022081612/5f1578ae0e51132d74583bf7/html5/thumbnails/27.jpg)
Absorption of P
P is absorbed from the small intestine along with Ca.
If Ca absorption is normal, so will be that of P.
![Page 28: CALCIUM PHOSPHORUS - Aligarh Muslim UniversityOBJECTIVES By the end of this session you should be able to: 1. Define principal elements & trace elements. 2. Enumerate the functions](https://reader036.fdocuments.in/reader036/viewer/2022081612/5f1578ae0e51132d74583bf7/html5/thumbnails/28.jpg)
MCQ
a) Calcitriol b) Low pH c) Oxalates d) Amino acids
All of the following factors increase calcium absorption, except:
[KEY: c]
![Page 29: CALCIUM PHOSPHORUS - Aligarh Muslim UniversityOBJECTIVES By the end of this session you should be able to: 1. Define principal elements & trace elements. 2. Enumerate the functions](https://reader036.fdocuments.in/reader036/viewer/2022081612/5f1578ae0e51132d74583bf7/html5/thumbnails/29.jpg)
Calcium-Phosphate HOMEOSTASIS
![Page 30: CALCIUM PHOSPHORUS - Aligarh Muslim UniversityOBJECTIVES By the end of this session you should be able to: 1. Define principal elements & trace elements. 2. Enumerate the functions](https://reader036.fdocuments.in/reader036/viewer/2022081612/5f1578ae0e51132d74583bf7/html5/thumbnails/30.jpg)
Normal Levels & Requirements
CALCIUM
9-11 mg/dL
1000 mg
Normal plasma level
Daily requirement
PHOSPHORUS
2.5-4 mg/dL
700 mg
Normal plasma level
Daily requirement
![Page 31: CALCIUM PHOSPHORUS - Aligarh Muslim UniversityOBJECTIVES By the end of this session you should be able to: 1. Define principal elements & trace elements. 2. Enumerate the functions](https://reader036.fdocuments.in/reader036/viewer/2022081612/5f1578ae0e51132d74583bf7/html5/thumbnails/31.jpg)
Calcium-Phosphate Homeostasis
Body’s property to maintain the normal plasma level of Ca & P.
Ca-P homeostasis is mediated by: » Vit-D (calcitriol) » PTH » Calcitonin
![Page 32: CALCIUM PHOSPHORUS - Aligarh Muslim UniversityOBJECTIVES By the end of this session you should be able to: 1. Define principal elements & trace elements. 2. Enumerate the functions](https://reader036.fdocuments.in/reader036/viewer/2022081612/5f1578ae0e51132d74583bf7/html5/thumbnails/32.jpg)
Cholecalciferol (Vitamin D3)
Ergocalciferol (Vitamin D2)
7-Dehydrocholesterol Calcidiol Calcitriol
Vitamin D 25- Hydroxylase
Vitamin D 1α- Hydroxylase
PTH
↓ Serum Phosphate
FGF23
↑ Serum Phosphate
Vitamin-D activation
![Page 33: CALCIUM PHOSPHORUS - Aligarh Muslim UniversityOBJECTIVES By the end of this session you should be able to: 1. Define principal elements & trace elements. 2. Enumerate the functions](https://reader036.fdocuments.in/reader036/viewer/2022081612/5f1578ae0e51132d74583bf7/html5/thumbnails/33.jpg)
GI System
Calcium
Phosphate
Renal System
Bones
Endocrine System
Food
Feces
Absorption
Filtration Reabsorption
Urine
Bone Turnover
(Mediated by Hormones)
![Page 34: CALCIUM PHOSPHORUS - Aligarh Muslim UniversityOBJECTIVES By the end of this session you should be able to: 1. Define principal elements & trace elements. 2. Enumerate the functions](https://reader036.fdocuments.in/reader036/viewer/2022081612/5f1578ae0e51132d74583bf7/html5/thumbnails/34.jpg)
Calcium, Phosphate
Calcium, Phosphate
Calcium, Phosphate
Calcium, Phosphate
Calcitriol
Calcitriol
PTH PTH, Calcitriol
Calcitonin
Calcitonin
Calcium Phosphate
PTH
GI Tract
Kidneys
Bones FGF-23
Net Effect
Calcitriol: ↑ calcium, ↑ phosphate PTH: ↑ calcium, ↓ phosphate Calcitonin: ↓ calcium, ↓ phosphate
Ca-P homeostasis
![Page 35: CALCIUM PHOSPHORUS - Aligarh Muslim UniversityOBJECTIVES By the end of this session you should be able to: 1. Define principal elements & trace elements. 2. Enumerate the functions](https://reader036.fdocuments.in/reader036/viewer/2022081612/5f1578ae0e51132d74583bf7/html5/thumbnails/35.jpg)
Summary
Calcitriol Intestine Kidneys Bones
PTH Intestine Kidneys Bones
Calcitonin Intestine Kidneys Bones
↑ absorption of Ca & P
↑ reabsorption of Ca & P ↑ bone resorption
↑ Ca (& ↓ P ) reabsorption ↑ resorption & ↓ mineralization
↓ reabsorption of Ca & P ↓ bone resorption
↑ Calcium
↑ Phosphate
↑ Calcium
↓ Phosphate
↓ Calcium
↓ Phosphate
Acts via calcitriol
Hormone Organ Action Net Effect
![Page 36: CALCIUM PHOSPHORUS - Aligarh Muslim UniversityOBJECTIVES By the end of this session you should be able to: 1. Define principal elements & trace elements. 2. Enumerate the functions](https://reader036.fdocuments.in/reader036/viewer/2022081612/5f1578ae0e51132d74583bf7/html5/thumbnails/36.jpg)
MCQ
a) Calcitriol b) FGF23 c) Decreased serum phosphate d) Increased serum phosphate
Which of the following factors increases the activity of 1α- hydroxylase?
[KEY: c]
![Page 37: CALCIUM PHOSPHORUS - Aligarh Muslim UniversityOBJECTIVES By the end of this session you should be able to: 1. Define principal elements & trace elements. 2. Enumerate the functions](https://reader036.fdocuments.in/reader036/viewer/2022081612/5f1578ae0e51132d74583bf7/html5/thumbnails/37.jpg)
MCQ
a) Calcitriol b) PTH c) FGF23 d) Calcitonin
Urinary excretion of phosphate is increased by all, except:
[KEY: a]
![Page 38: CALCIUM PHOSPHORUS - Aligarh Muslim UniversityOBJECTIVES By the end of this session you should be able to: 1. Define principal elements & trace elements. 2. Enumerate the functions](https://reader036.fdocuments.in/reader036/viewer/2022081612/5f1578ae0e51132d74583bf7/html5/thumbnails/38.jpg)
MCQ
a) Both A and R are true and R is the correct explanation of A.
b) Both A and R are true but R is NOT the correct explanation of A.
c) A is true but R is false. d) A is false but R is true. e) Both A and R are false
Assertion: PTH decreases serum P levels. Reason: PTH enhances bone resorption.
[KEY: b]
![Page 39: CALCIUM PHOSPHORUS - Aligarh Muslim UniversityOBJECTIVES By the end of this session you should be able to: 1. Define principal elements & trace elements. 2. Enumerate the functions](https://reader036.fdocuments.in/reader036/viewer/2022081612/5f1578ae0e51132d74583bf7/html5/thumbnails/39.jpg)
CAN YOU ??? Define principal elements & trace elements. 1.
Enumerate the functions of Ca & P. 2.
Tell the normal levels of Ca & P in blood. 3.
Discuss the factors affecting the absorption of Ca.
4.
Discuss the role of Vit-D, PTH & Calcitonin in Ca-P homeostasis.
5.