ca & phosphorous met. - kush

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_language


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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/Energy


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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.html


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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/Secosteroids


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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_resorption


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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_tubule


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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/Intestine


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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/Polyuria


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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_acid


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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/Parathyroid


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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/Tooth


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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_pain


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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_D


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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_disturbance


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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_disturbance


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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.

ca & phosphorous met. - kush

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