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8/2/2019 CA & Phosphorous Met. - Kush
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Presented by:
Kush Pathak
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Introduction
Definitions
Classification of Minerals
CalciumFunctions, Source & Distribution, Dietary
requirements, uses, Calcium Balance
PhosphorousFunctions, Sources, requirements
Absorption of Calcium and Phosphorous
Excretion of calcium and phosphorous
Calcium Homeostasis
Hormonal control of calcium & Phosphate metabolism
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Effects of other hormones on calcium metabolism
Applied Aspects
Conclusion
References
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The 14 minerals - Calcium, Phosphorus, Magnesium, Sodium,
Potassium, Chloride, and Sulfur, Iron, Manganese, Copper, Iodine,
Zinc, Fluoride, and Selenium.
These 14 essential minerals are crucial to the growth and
production of bones, teeth, hair, blood, nerves, skin, vitamins,
enzymes and hormones; and the healthy functioning of nerve
transmission, blood circulation, fluid regulation, cellular integrity,
energy production and muscle contraction.
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Metabolism- Is the set of chemical reactions that happen in the
cells of living organisms to sustain life.
These processes allow organisms to grow and reproduce, maintain
their structures, and respond to their environments.
The word metabolism can also refer to all chemical reactions that
occur in living organisms, including digestion and the transport of
substances into and between different cells, in which case the setof reactions within the cells is called intermediary
metabolism or intermediate metabolism.
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Divided into two parts:
Anabolism taken from the Greekana, "upward", and ballein,
"to throw", is the set of metabolic pathways that constructmolecules from smaller units.
Anabolism is powered by catabolism, where large molecules are
broken down into smaller parts and then used up in respiration.
Many anabolic processes are powered by adenosine
triphosphate (ATP)
Anabolic processes tend toward "building up" organs and tissues.
These processes produce growth and differentiation of cells andincrease in body size, a process that involves synthesis of complex
molecules.
http://en.wikipedia.org/wiki/Greek_languagehttp://en.wikipedia.org/wiki/Metabolic_pathwayhttp://en.wikipedia.org/wiki/Cellular_respirationhttp://en.wikipedia.org/wiki/Adenosine_triphosphatehttp://en.wikipedia.org/wiki/Adenosine_triphosphatehttp://en.wikipedia.org/wiki/Adenosine_triphosphatehttp://en.wikipedia.org/wiki/Adenosine_triphosphatehttp://en.wikipedia.org/wiki/Adenosine_triphosphatehttp://en.wikipedia.org/wiki/Cellular_respirationhttp://en.wikipedia.org/wiki/Metabolic_pathwayhttp://en.wikipedia.org/wiki/Metabolic_pathwayhttp://en.wikipedia.org/wiki/Metabolic_pathwayhttp://en.wikipedia.org/wiki/Greek_language8/2/2019 CA & Phosphorous Met. - Kush
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Catabolism - (Greekkata = downward + ballein = to throw) is
the set of metabolic pathways that break down large molecules
into smaller units and release energy.
In catabolism, large molecules such
as polysaccharides, lipids, nucleic acids and proteins are broken
down into smaller units such as monosaccharides, fatty
acids, nucleotides, and amino acids, respectively.
There are many signals that control catabolism. Most of the known
signals are hormones and the molecules involved
in metabolism itself.Endocrinologists have traditionally classified
many of the hormones as anabolic or catabolic, depending on
which part of metabolism they stimulate
http://en.wikipedia.org/wiki/Energyhttp://en.wikipedia.org/wiki/Polysaccharidehttp://en.wikipedia.org/wiki/Lipidhttp://en.wikipedia.org/wiki/Nucleic_acidhttp://en.wikipedia.org/wiki/Proteinhttp://en.wikipedia.org/wiki/Monosaccharidehttp://en.wikipedia.org/wiki/Fatty_acidhttp://en.wikipedia.org/wiki/Fatty_acidhttp://en.wikipedia.org/wiki/Nucleotidehttp://en.wikipedia.org/wiki/Amino_acidhttp://en.wikipedia.org/wiki/Hormonehttp://en.wikipedia.org/wiki/Metabolismhttp://en.wikipedia.org/wiki/Endocrinologisthttp://en.wikipedia.org/wiki/Anabolichttp://en.wikipedia.org/wiki/Anabolichttp://en.wikipedia.org/wiki/Endocrinologisthttp://en.wikipedia.org/wiki/Metabolismhttp://en.wikipedia.org/wiki/Hormonehttp://en.wikipedia.org/wiki/Amino_acidhttp://en.wikipedia.org/wiki/Amino_acidhttp://en.wikipedia.org/wiki/Amino_acidhttp://en.wikipedia.org/wiki/Nucleotidehttp://en.wikipedia.org/wiki/Fatty_acidhttp://en.wikipedia.org/wiki/Fatty_acidhttp://en.wikipedia.org/wiki/Fatty_acidhttp://en.wikipedia.org/wiki/Monosaccharidehttp://en.wikipedia.org/wiki/Proteinhttp://en.wikipedia.org/wiki/Nucleic_acidhttp://en.wikipedia.org/wiki/Nucleic_acidhttp://en.wikipedia.org/wiki/Nucleic_acidhttp://en.wikipedia.org/wiki/Lipidhttp://en.wikipedia.org/wiki/Polysaccharidehttp://en.wikipedia.org/wiki/Energy8/2/2019 CA & Phosphorous Met. - Kush
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Major minerals - Major minerals are needed in comparativelylarger amounts by the body than trace minerals.
The major minerals are the six dietary minerals our body needs inthe largest amounts. They're necessary for many processes in body,especially fluid balance, maintenance of bones and teeth, muscle
contractions and nervous system function.
They are: chloride, magnesium, phosphorous, potassium, sodium.
Trace minerals - These minerals are all essential for good health,
but your body only needs a very small amount of each one.They're important for immune system function, energy,metabolism and antioxidant protection.
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Chromium is necessary for normal metabolism and storage ofsugar and starch. It's found in a wide variety of foods, sodeficiencies are very rare.
Copper - Body needs copper for strong bones, blood vessels andbones, plus copper is a component of some antioxidant reactions.It's found in foods like organ meats, seafood and whole grains.
Fluoride - Fluoride helps to keep your bones and teeth strong.You'll find it in fluoridated drinking water, tea, and seafood.
Iodine - Iodine is used to make thyroid hormone and is necessaryfor normal thyroid gland function. It's found in iodized salt,seafood and plant-based foods grown in soil that contains iodine.
Iron - Iron is used to move oxygen to all the cells of your body,but you also need iron for normal immune system function andnormal cell growth. It's found in meat, poultry, fish, legumes, andspinach.
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Manganese - Manganese is needed for antioxidant reactions, and
healthy nervous system function. It's found in nuts, seeds,
legumes, and whole grains.
Molybdenum - Molybdenum is a component of enzymes your
body uses for breaking down amino acids, as well as drugs and
toxins. It's found in a wide variety of foods, especially legumes
and nuts.
Selenium - Selenium is used in antioxidant reactions that help
protect the cells in your body and is important for normal thyroid
function. It's found in many plant-based foods such as whole
grains, nuts, seeds and legumes.
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Plasma calcium :
Normal level - 8.6-10.6 mg/dl
i. 50% - present as ionized form
ii. 40% - bound to proteins i.e. albumin
iii. 10% - complexed calciumcalcium citrate, bicarbonate andphosphate.
Ca X P in serum
children50 and adults 30-40.
Calcium: Phosphate ratio in diet:
During growth1:1
After cessation of growth- 1: 2.
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0-6 months 210 mg
6-12 months 270 mg
1-3 years 500 mg
4-8 years 800 mg 9-18 years 1,300 mg
Adults 0.5-0.8 g
51-70+ years 1,200 mg
Pregnant women 19-50 years 1,000 mg
Source: Dietary Reference Intakes, Food and Nutrition Board,National Academy of Sciences-Institute of Medicine, 1997
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Hormone secretionHormone action :
Ca+2 acts as second messenger, in the action of hormones
Neuromuscular transmission
Muscular contraction CBP- Calmoduli,Troponin and calbindin
It is essential for the clotting of blood -. It helps in the
formation of activated forms of factor IX, X, II and in the
formation of prothrombin activator.
Formation of bone and teeth
It regulates the permeability of the capillary walls.
Cell division, mitosis and fertilization
Endocytosis, Exocytosis, cellular motility
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RICH SOURCES OF CALCIUM
Dairy Products, such as Milk, Cheese, and Yogurt
Canned Salmon and Sardines with Bones
Leafy Green Vegetables, such as Broccoli, Spinach
Calcium-Fortified foods - from Orange juice to Cereals and CrackersIce Cream, Oysters, Ricotta.
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Relationship between our calcium intake and calcium loss is calledcalcium balance.
When we intake more calcium than the amount used by our body, weachieve a positive calcium balance.
On the other hand, if we use more calcium than we intake, we have anegative calcium balance.
Our body requires a positive calcium balance to support bone growth.
Negative calcium balance occurs as a result of calcium loss through theexcretion of urine, feces and sweat.
A negative calcium balance can lead to a loss of bone mineral density andbone mass.
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Phosphorus is the second most abundant mineral in the body and85% of it is found in the bones.
Non metallic element - blood, muscles, nerves, bones, and teeth
and a component of adenosine tri-phosphate
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Distribution
Total phosphate:500-800 mg
bones andteeth
Inorganic(0.5-1mg/dl) (Adults:3-4mg/dl)
(children:5-6mg/dl)
Normal plasma levels:
2.5-4.5 mg/dl
Organic
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Hydroxyapatite and Phospholipids are major structuralcomponents ofcell membranes.
Energy production and storage - ATP
In bone, phosphorus is a constituent of crystal hydroxyapaptiteCa10(PO4)6(OH)2. Hydroxyapatite is deposited in the organicmatrix during the mineralization process, giving bone its strength.
In soft tissues, phosphorus plays several different roles1:
Structural Component : Phosphorus forms phospholipidmolecules that are major constituents of cell membranes andintracellular organelles.
http://lpi.oregonstate.edu/infocenter/glossary.htmlhttp://lpi.oregonstate.edu/infocenter/glossary.htmlhttp://lpi.oregonstate.edu/infocenter/glossary.htmlhttp://lpi.oregonstate.edu/infocenter/glossary.html8/2/2019 CA & Phosphorous Met. - Kush
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INTERMEDIATE METABOLISMRelease of high-energy phosphorus by hydrolysis of adenosinetriphosphate (ATP) provides the main energy source for variousmetabolic processes and for muscle contraction. Phosphorus-
containing proteins play essential roles in the mitochondrial electrontransport system.
The level of intracellular phosphorus is also an essential regulator ofenzymes in the glycolytic pathway.
The concentration of 2,3-diphosphoglycerate in red blood cellsfacilitates the release of oxygen from oxyhemoglobin into bodytissue.
Ionized inorganic phosphorus also serves as a buffer to maintain theproper pH of body fluids.
GENETIC MATERIALPhosphorus is an essential component of DNA and RNAmolecules.
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The Recommended Dietary Allowance (RDA)
Life Stage Age Males(mg/day) Females
Infants 0-6 months 100 100
Infants 7-12 months 275 275
Children 1-3 years 460 460
Children 4-8 years 500 500
Adolescents 14-18 years 1,250 1,250
Adults 19 years and older 700 700
Pregnancy 19 years and older 700
Breast-feeding 18 years and younger 1,250
Breast-feeding19 years and older 700
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Food Serving Phosphorus
(mg)
Milk, 8 ounces 247
Yogurt, plain nonfat 8 ounces 385Cheese, 1 ounce 131
Egg 1 large, cooked 104
Chicken 3 ounces, cooked* 155
Fish, salmon 3 ounces, cooked* 252Bread, whole wheat 1 slice 57
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Ca+2 is poorly absorbed from intestine.
Vitamin D and PTH promotes absorption
Slight acidity or neutral pH is needed for Ca absorption
Active transportWhere Ca absorption occurs against
Ca concentration and is dependent on 1,25 (OH)2 cc.-Duodenum
Passive diffusion occurs lower down in the small intestine andaccounts only for 15%.
Renal excretion of calcium and phosphorus
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pH of intestinal contents
acidic pH favors absorption
alkaline medium - lowered
Composition of diet :
High protein diet favors absorption
Fatty acidsdecreases calcium absorption
Sugars and organic acids
Citric acid also increases absorption- chelator
Phytic acid forms insoluble calcium salts
Minerals : Excess phosphates lowers calcium absorption, high
magnesium content decreases Ca absorption
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Health status
Hormonal control : PTH, calcitonin, Vit-D, glucocorticoids
decrease the intestinal transport of calcium.
Sex harmones: Increase intestinal absorption
Stimulate mineralization
Decrease renal excretion
Thyroid harmones: Hyperthyroidism-increased bone resorption
Factors regulating absorption Three tissues-
Three harmones-
Three cells -
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Factors favoring
Factors decreasing
Mechanismcotransport Na
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80% in
Urine
Remaining
Faeces
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Vitamin D
Parathyroid
Hormone (PTH)
Calcitonin Minor regulator
Major regulators
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Vitamin D is a group of fat-soluble secosteroids. In humans,vitamin D is unique both because it functions as a prohormone and
because the body can synthesize it (as vitamin D3) when sun
exposure is adequate (hence its nickname, the "sunshine vitamin").
Vitamin D fits within the definition of vitamin as it is "an organic
compound required as a vital nutrient in tiny amounts by an
organism."
An organic chemical compound (or related set of compounds) iscalled a vitamin when it cannot be synthesized in sufficient
quantities by an organism, and must be obtained from the diet
http://en.wikipedia.org/wiki/Secosteroidshttp://en.wikipedia.org/wiki/Prohormonehttp://en.wikipedia.org/wiki/Prohormonehttp://en.wikipedia.org/wiki/Secosteroids8/2/2019 CA & Phosphorous Met. - Kush
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Cod liver oil
Fish- Salmon
Egg, liver
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According to U.S. institute of medicine daily intake of Vitamin Dshould be :
170 years of age: 600 IU/day (15 g/day)
71+ years of age: 800 IU/day (20 g/day)
Pregnant/lactating: 600 IU/day (15 g/day)
Adults2.5mg
Lactating mother
Pregnancy
Adolescents
Infants
1mg = 40 IU
Based on climatic conditions
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Intestinal calcium absorption
Intestinal phosphorus absorption
Decreases Renal Calcium and Phosphorus excretion
Effect of Vitamin D on Bone and its relation to Parathyroid
hormone
Bone absorption and Bone deposition
Smaller quantitiesbone calcifications.
Target sites are : Intestine, Kidney and Bone
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VITAMIN D
INTESTINE
Calcium & Phosphate
absorption
Weak
action
Calcium
reabsorption
Bone resorption
Plasma
calcium &Phosphate levels
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Lack of Vitamin D
Lack of Calcium
Lack of Phosphate
Increase level of PTH
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The major hormone for
regulation of the serum
[Ca2+]
Synthesized and secreted by
the chief cells of the
parathyroid glands.
PTH-rp-produced by
different genes
both elevates calium level
Also binds with PTH
receptors
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BONE
PTH stimulates bone osteoblasts to increase growth &
metabolic activity
PTH stimulated bone resorption releases calcium & phosphate
into blood KIDNEY
PTH increases reabsorption of calcium & reduces reabsorption
of phosphate
Net effect of its action is increased calcium & reducedphosphate in plasma
INTESTINE
Increases calcium reabsorption via vitamin D
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Secretion of PTH
Controlled by the serum [Ca2+] by negative feedback
Mild decreases in serum [Mg2+] also stimulate PTH secretion.
Severe decreases in serum [Mg2+] inhibit PTH
Secretion and produce symptoms of hypo parathyroidism.
The second messenger for PTH secretion by the parathyroid glandis cyclic AMP.
Estimation: two sides immuno radiometric assay
Degradation: kupffer cells of liver
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Pre-pro PTH (115 amino acids)
Pro-PTH (90 amino acids)
PTH (84 amino acids)
Enzymatic deletion of 25 aminoacids
Enzymatic deletion of 6 aminoacids
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Bone
It enhances the release of calcium from the large reservoir contained in the
bones. Bone resorption is the normal destruction of bone by osteoclasts, which areindirectly stimulated by PTH.
Stimulation is indirect since osteoclasts do not have a receptor for PTH; rather,
PTH binds to osteoblasts, the cells responsible for creating bone. Binding
stimulates osteoblasts to increase their expression of RANKL and inhibits theirexpression ofOsteoprotegerin(OPG).
OPG binds to RANKL and blocks it from interacting with RANK, a receptor for
RANKL. The binding of RANKL to RANK (facilitated by the decreased amount
of OPG) stimulates these osteoclast precursors to fuse, forming new osteoclasts,
which ultimately enhances bone resorption.
http://en.wikipedia.org/wiki/Bone_resorptionhttp://en.wikipedia.org/wiki/Osteoclasthttp://en.wikipedia.org/wiki/Osteoblasthttp://en.wikipedia.org/wiki/Osteoprotegerinhttp://en.wikipedia.org/wiki/RANKLhttp://en.wikipedia.org/wiki/Bone_resorptionhttp://en.wikipedia.org/wiki/Bone_resorptionhttp://en.wikipedia.org/wiki/Bone_resorptionhttp://en.wikipedia.org/wiki/Bone_resorptionhttp://en.wikipedia.org/wiki/RANKLhttp://en.wikipedia.org/wiki/Osteoprotegerinhttp://en.wikipedia.org/wiki/Osteoblasthttp://en.wikipedia.org/wiki/Osteoclasthttp://en.wikipedia.org/wiki/Bone_resorptionhttp://en.wikipedia.org/wiki/Bone_resorptionhttp://en.wikipedia.org/wiki/Bone_resorption8/2/2019 CA & Phosphorous Met. - Kush
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PTH accelerates removal of calcium from bone by two
processes
1) Osteolysis
Bone fluid Ca OCM Ca ECF
2) Stimulates osteoclastic resorption of completely mineralized
bone
PTH
Calcium &
Phosphate
ECF
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Kidney -
It enhances active reabsorption of calcium and magnesium
from distal tubules and the thick ascending limb.
As bone is degraded, both calcium and phosphate are released. It
also decreases the reabsorption of phosphate, with a net loss in
plasma phosphate concentration.
When the calcium:phosphate ratio increases, more calcium is free
in the circulation
http://en.wikipedia.org/wiki/Distal_tubulehttp://en.wikipedia.org/wiki/Distal_tubulehttp://en.wikipedia.org/wiki/Distal_tubulehttp://en.wikipedia.org/wiki/Distal_tubule8/2/2019 CA & Phosphorous Met. - Kush
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Intestine via Kidney
It enhances the absorption of calcium in the intestine by increasing
the production of activated vitamin D. Vitamin D activation occurs
in the kidney.
PTH up-regulates 25-hydroxyvitamin D3 1-alpha-hydroxylase, the
enzyme responsible for 1-alpha hydroxylation of25-hydroxy
vitamin D, converting vitamin D to its active form (1,25-
dihydroxy vitamin D). This activated form of vitamin D increases the absorption of
calcium (as Ca2+ ions) by the intestine via calbindin.
http://en.wikipedia.org/wiki/Intestinehttp://en.wikipedia.org/wiki/Vitamin_Dhttp://en.wikipedia.org/wiki/25-hydroxyvitamin_D3_1-alpha-hydroxylasehttp://en.wikipedia.org/wiki/25-hydroxyvitamin_D3_1-alpha-hydroxylasehttp://en.wikipedia.org/wiki/25-hydroxyvitamin_D3_1-alpha-hydroxylasehttp://en.wikipedia.org/wiki/Hydroxylationhttp://en.wikipedia.org/wiki/25-hydroxy_vitamin_Dhttp://en.wikipedia.org/wiki/25-hydroxy_vitamin_Dhttp://en.wikipedia.org/wiki/1,25-dihydroxy_vitamin_Dhttp://en.wikipedia.org/wiki/1,25-dihydroxy_vitamin_Dhttp://en.wikipedia.org/wiki/Calbindinhttp://en.wikipedia.org/wiki/Calbindinhttp://en.wikipedia.org/wiki/1,25-dihydroxy_vitamin_Dhttp://en.wikipedia.org/wiki/1,25-dihydroxy_vitamin_Dhttp://en.wikipedia.org/wiki/1,25-dihydroxy_vitamin_Dhttp://en.wikipedia.org/wiki/25-hydroxy_vitamin_Dhttp://en.wikipedia.org/wiki/25-hydroxy_vitamin_Dhttp://en.wikipedia.org/wiki/25-hydroxy_vitamin_Dhttp://en.wikipedia.org/wiki/25-hydroxy_vitamin_Dhttp://en.wikipedia.org/wiki/Hydroxylationhttp://en.wikipedia.org/wiki/25-hydroxyvitamin_D3_1-alpha-hydroxylasehttp://en.wikipedia.org/wiki/25-hydroxyvitamin_D3_1-alpha-hydroxylasehttp://en.wikipedia.org/wiki/25-hydroxyvitamin_D3_1-alpha-hydroxylasehttp://en.wikipedia.org/wiki/25-hydroxyvitamin_D3_1-alpha-hydroxylasehttp://en.wikipedia.org/wiki/25-hydroxyvitamin_D3_1-alpha-hydroxylasehttp://en.wikipedia.org/wiki/25-hydroxyvitamin_D3_1-alpha-hydroxylasehttp://en.wikipedia.org/wiki/25-hydroxyvitamin_D3_1-alpha-hydroxylasehttp://en.wikipedia.org/wiki/25-hydroxyvitamin_D3_1-alpha-hydroxylasehttp://en.wikipedia.org/wiki/25-hydroxyvitamin_D3_1-alpha-hydroxylasehttp://en.wikipedia.org/wiki/25-hydroxyvitamin_D3_1-alpha-hydroxylasehttp://en.wikipedia.org/wiki/Vitamin_Dhttp://en.wikipedia.org/wiki/Intestine8/2/2019 CA & Phosphorous Met. - Kush
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Calcitonin is a peptide hormone secreted by the parafollicular or
C cells of the thyroid gland.
It is synthesized as the preprohormone & released in response to
high plasma calcium.
Calcitonin acts on bone osteoclasts to reduce bone resorption.
Net result of its action is a decline in plasma calcium & phosphate
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The main effect is a rapid fall of plasma calcium levels.
Target site
Bone
Mechanism
Adultweak effect
Children ---- Greater effect
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GROWTH HORMONE
INSULIN
TESTOSTERONE
OESTROGENS
LACTOGEN & PROLACTIN
STEROIDS
THYROID HORMONES
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GROWTH HORMONE
ca absorption
insulin like growth factor
stomatomedian C
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Calciumdeposition
Calciummobilization
Calciumdeposition
Calciummobilization
OSTEOPOROSIS
Young Age Old Age
(Post menopausal)
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Placental lactogen Prolactin
Increase hydroxylation of Vitamin D
Increase calcium & phosphate absorption
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In infants
In adults
Glucocorticoids-anti vit D action
inhibits protein synthesis
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Hypercalcaemia
Hypocalcaemia
Tetany
Rickets
Osteomalacia Vitamin D resistant rickets
Renal Rickets
Osteoporosis
Hypervitaminosis
Hyperparathyroidism
Hypoparathyroidism
Hyperphosphataemia
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Hypercalcemia indicates a concentration of
blood calcium higher than normal. The normal
concentration of calcium and phosphate in blood
and extracellular fluid is near the saturation
point; elevations can lead to diffuse precipitation
of calcium phosphate in tissues, leading to
widespread organ dysfunction and damage.
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Stones (renal or biliary)
-Bones (bone pain)
-Groans (abdominal pain, nausea and vomiting)
-Thrones (sit on throne - polyuria)
-Psychiatric overtones (Depression 30-40%, anxiety, cognitive
dysfunction, insomnia, coma)
Other symptoms can include fatigue, anorexia, and pancreatitis
http://en.wikipedia.org/wiki/Polyuriahttp://en.wikipedia.org/wiki/Fatigue_(physical)http://en.wikipedia.org/wiki/Anorexia_(symptom)http://en.wikipedia.org/wiki/Pancreatitishttp://en.wikipedia.org/wiki/Pancreatitishttp://en.wikipedia.org/wiki/Anorexia_(symptom)http://en.wikipedia.org/wiki/Fatigue_(physical)http://en.wikipedia.org/wiki/Polyuria8/2/2019 CA & Phosphorous Met. - Kush
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Hypocalcaemia
level of calcium in the blood (
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Exposure to hydrofluoric acid
As a complication ofpancreatitis
As a result of hyperventilation
Alkalosis, often caused by hyperventilation
Neonatal hypocalcaemia
Symptoms
Petechiae
Parasthesia
Tetany
Laryngospasm Cardiac arrythemias
Tetany
http://en.wikipedia.org/wiki/Hydrofluoric_acidhttp://en.wikipedia.org/wiki/Pancreatitishttp://en.wikipedia.org/wiki/Alkalosishttp://en.wikipedia.org/wiki/Alkalosishttp://en.wikipedia.org/wiki/Pancreatitishttp://en.wikipedia.org/wiki/Hydrofluoric_acid8/2/2019 CA & Phosphorous Met. - Kush
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Tetany
Cause - lack of calcium, excessive phosphate,
Underfunction of the parathyroid gland can lead totetany, Low levels of magnesium can lead to tetany
Types ------Hypocalcemic tetanyLatent/Subclinical tetany
Hypocalcemic tetany- Carpopedal spasm
Laryngeal stridor
CVS changes
http://en.wikipedia.org/wiki/Parathyroidhttp://en.wikipedia.org/wiki/Hypomagnesemiahttp://en.wikipedia.org/wiki/Hypomagnesemiahttp://en.wikipedia.org/wiki/Parathyroid8/2/2019 CA & Phosphorous Met. - Kush
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LATENT TETANY
TROUSSEAUS sign
CHVOSTEKS sign
ERBS sign- An indication of tetany in which the
electric excitability of the muscles increases.a
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Dystrophic calcification-
eg- pulp stones
Metastatic calcification-
eg-hyper parathyroidism
Calcinosis -
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Cf Bone pain or tenderness
dental problems
muscle weakness
Hypocalcemia (low level ofcalcium in the blood)
Tetany (uncontrolled muscle
spasms all over the body)
Craniotabes (soft skull)
Costochondral swelling (aka
"rickety rosary" or "rachitic
rosary")
Harrison's groove
http://en.wikipedia.org/wiki/Toothhttp://en.wikipedia.org/wiki/Musclehttp://en.wikipedia.org/wiki/Hypocalcemiahttp://en.wikipedia.org/wiki/Tetany_(medical_sign)http://en.wikipedia.org/wiki/Craniotabeshttp://en.wikipedia.org/wiki/Costochondral_jointhttp://en.wikipedia.org/wiki/Rachitic_rosaryhttp://en.wikipedia.org/wiki/Rachitic_rosaryhttp://en.wikipedia.org/wiki/Harrison's_groovehttp://en.wikipedia.org/wiki/Harrison's_groovehttp://en.wikipedia.org/wiki/Harrison's_groovehttp://en.wikipedia.org/wiki/Harrison's_groovehttp://en.wikipedia.org/wiki/Rachitic_rosaryhttp://en.wikipedia.org/wiki/Rachitic_rosaryhttp://en.wikipedia.org/wiki/Rachitic_rosaryhttp://en.wikipedia.org/wiki/Costochondral_jointhttp://en.wikipedia.org/wiki/Craniotabeshttp://en.wikipedia.org/wiki/Tetany_(medical_sign)http://en.wikipedia.org/wiki/Hypocalcemiahttp://en.wikipedia.org/wiki/Musclehttp://en.wikipedia.org/wiki/Tooth8/2/2019 CA & Phosphorous Met. - Kush
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Osteomalacia
Occurs in adults
Flat bones affected
Softening and distortion of skeletal tissues
Fractures along the nutrient arteries
Dental findings
Severe periodontitis
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Renal Osteodystrophy
Associated with Chronic renal disease
1--hydroxylase not synthesized by kidneys
Features
Bone pain
Joint pain
Bone deformation
Bone fracture
http://en.wikipedia.org/wiki/Bone_painhttp://en.wikipedia.org/wiki/Bone_painhttp://en.wikipedia.org/wiki/Arthralgiahttp://en.wikipedia.org/wiki/Bone_fracturehttp://en.wikipedia.org/wiki/Bone_fracturehttp://en.wikipedia.org/wiki/Arthralgiahttp://en.wikipedia.org/wiki/Bone_painhttp://en.wikipedia.org/wiki/Bone_pain8/2/2019 CA & Phosphorous Met. - Kush
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Unlike rickets
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Hypervitaminosis D is a state ofvitamin D toxicity.
The recommended daily allowance is 15 g/d (600 IU per day).
Overdose has been observed at 1,925 g/d (77,000 IU per day).
Acute overdose requires between 15,000 g/d (600,000 IU per
day) and 42,000 g/d (1,680,000 IU per day) over a period of
several days to months Tiredness
Loss of appetite
Nausea
Vomiting Polyuria
Dehydration
Loss of muscle tone
http://en.wikipedia.org/wiki/Vitamin_Dhttp://en.wikipedia.org/wiki/Reference_Daily_Intakehttp://en.wikipedia.org/wiki/Reference_Daily_Intakehttp://en.wikipedia.org/wiki/Reference_Daily_Intakehttp://en.wikipedia.org/wiki/Reference_Daily_Intakehttp://en.wikipedia.org/wiki/Reference_Daily_Intakehttp://en.wikipedia.org/wiki/Reference_Daily_Intakehttp://en.wikipedia.org/wiki/Vitamin_Dhttp://en.wikipedia.org/wiki/Vitamin_Dhttp://en.wikipedia.org/wiki/Vitamin_D8/2/2019 CA & Phosphorous Met. - Kush
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Causes Symptoms
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Decrease level of PTH
Due to
Surgical removal of parathyroid gland
Congenital absence of the gland
Atrophy of the gland
Diagnosis
Decrease plasma calcium level & increase plasma
phosphate level
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Clinical signs & symptoms
Hyperactive reflexive
Spontaneous muscular contractions
Convulsions Laryngeal spasm
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Hyperphosphatemia is an electrolyte disturbance in which there isan abnormally elevated level of phosphate inthe blood. Often, calcium levels are lowered (hypocalcemia) due toprecipitation of phosphate with the calcium in tissues.
Causeschronic renal faliure, osteomalacia
Signs &Symptoms - ectopic calcification,secondary hyperparathyroidism, and renal osteodystrophy.
http://en.wikipedia.org/wiki/Electrolyte_disturbancehttp://en.wikipedia.org/wiki/Phosphatehttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Calcium_in_biologyhttp://en.wikipedia.org/wiki/Hypocalcemiahttp://en.wikipedia.org/wiki/Ectopic_calcificationhttp://en.wikipedia.org/wiki/Hyperparathyroidismhttp://en.wikipedia.org/wiki/Renal_osteodystrophyhttp://en.wikipedia.org/wiki/Renal_osteodystrophyhttp://en.wikipedia.org/wiki/Renal_osteodystrophyhttp://en.wikipedia.org/wiki/Renal_osteodystrophyhttp://en.wikipedia.org/wiki/Hyperparathyroidismhttp://en.wikipedia.org/wiki/Ectopic_calcificationhttp://en.wikipedia.org/wiki/Ectopic_calcificationhttp://en.wikipedia.org/wiki/Ectopic_calcificationhttp://en.wikipedia.org/wiki/Hypocalcemiahttp://en.wikipedia.org/wiki/Calcium_in_biologyhttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Phosphatehttp://en.wikipedia.org/wiki/Electrolyte_disturbancehttp://en.wikipedia.org/wiki/Electrolyte_disturbancehttp://en.wikipedia.org/wiki/Electrolyte_disturbance8/2/2019 CA & Phosphorous Met. - Kush
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Hypophosphatemia is an electrolyte disturbance in which there isan abnormally low level ofphosphate in the blood.
Causes Refeeding syndrome, Respiratory alkalosis, alcohol
abuse, certain blood cancers such as lymphoma or leukemia,hereditary cause, hepatic paliure, tumor induced osteomalacia.
C/F - Muscle dysfunction and weakness, Mental status changes,
white cell dysfunction, Instability of cell membranes due to low
ATP levels
http://en.wikipedia.org/wiki/Electrolyte_disturbancehttp://en.wikipedia.org/wiki/Phosphatehttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Phosphatehttp://en.wikipedia.org/wiki/Electrolyte_disturbancehttp://en.wikipedia.org/wiki/Electrolyte_disturbancehttp://en.wikipedia.org/wiki/Electrolyte_disturbance8/2/2019 CA & Phosphorous Met. - Kush
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Understanding bone physiology is important in orthodonticinterventions involving manipulation of bone by the dentist should
be carried out only when the patient is in positive calcium balance.
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1. Textbook of Medical Physiology 10th ed, Guyton & Hall2. Essentials of Medical Physiology, k. Sembulingam & Prema
Sembulingam, 4th ed
3. Textbook of Medical Biochemistry, MN Chatterjee, RanaShinde,5th ed
4. Concise Medical Physiology, Sujit K Chaudhuri, 2nd ed
5. Clinical Oral PhysiologyTimothy s miles
6. Concise medical physiology- Chaudhuri
7. Principles & Practice of medicineDavidson ,6th edition
8. Bailey BJ, Calhoun KH, et al.Atlas of Head and Neck Surgery-Otolaryngology. Second Edition. Lippincott Williams andWilkins. Philadelphia, PA. c. 2001:236-245.
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Dackiw AP, Sussman JJ, et al. Relative Contributions of Technetium Tc99m Sestamibi Scintigraphy, Intraoperative Gamma Probe Detection, andthe Rapid Parathyroid Hormone Assay to the Surgical Management ofHyperparathyroidism. Archives of Surgery. 2000;135:550-557.
Marx SJ. Medical Progress: Hyperparathyroid and
Hypoparathyroid Disorders. The New England Journal ofMedicine. 2000;343:1863-1875.
Mitchell BK, Merrell RC, Kinder BK. Localization Studies inPatients with Hyperparathroidism. Surgical Clinics of North
America. 1995;75:483-498.
Reber PM, Hunter, H. Hypocalcemic Emergencies. MedicalClinics of North America. 1995; 79:93-106.