Low Ca

Stimulatiation releas of
PTH that workin on

Bon marrow Kedny

Dirct action:- Indirect action:-

Direct action:- Indirct action:-
Exit of the phosphor by Stiumulation kedny
Exit of free Destrction and exit urin to stimulation enzyme that activate
calsium and free Calsium-Phosphat separate of Calsium- Vitemin-D to
phosphat in to Complax that combont of phosphate Complex to absorbation of
blood bon repration low phospate Calsium
and Calsium

Repited to Calsium into normal reng

‫اﻋﺪاد ﻋﺒﺪاﻟﻤﻠﻚ اﻟﺤﺎرﺛﻲ‬

 ‫‪Calcium of egulation‬‬
‫==============‬
‫‪calcium‬‬
‫ﻋﻨﺼﺮ ﻣﻌﺪﻧﻲ ﻳﺤﻤﻞ ﺷﺤﻨﺔ ﻣﻮﺟﺒﺔ وﻳﻮﺟﺪ ﺧﺎرج اﻟﺨﻼﻳﺎ ‪،‬أﺳﺎﺳﻲ ﻟﻠﺘﻄﻮر اﻟﻄﺒﻴﻌﻲ و ﻟﻔﻌﺎﻟﻴﺎت اﻟﺠﺴﻢ ‪.‬‬
‫اﻟﻜﺎﻟﺴﻴﻮم ﻣﻜﻮن ﻫﺎم ﻟﻠﻌﻈﺎم و اﻷﺳﻨﺎن ‪،‬أﺳﺎﺳﻲ ﻟﻠﻌﺪﻳﺪ ﻣﻦ اﻟﻌﻤﻠﻴﺎت اﻻﺳﺘﻘﻼﺑﻴﺔ ‪ ,‬ﻣﻦ ﺿﻤﻨﻬﺎ ﻋﻤﻞ‬
‫اﻷﻋﺼﺎب ‪ ,‬ﺗﻘﺒﺾ اﻟﻌﻀﻼت ‪ ,‬و ﺗﺨﺜﺮ اﻟﺪم ‪ .‬اﻟﺤﺎﺟﺔ اﻟﻴﻮﻣﻴﺔ اﻟﻄﺒﻴﻌﻴﺔ ﻣﻦ اﻟﻜﺎﻟﺴﻴﻮم ﻫﻲ ﺣﻮاﻟﻲ ‪ 1‬غ‬

‫ﺗﻮزﻳﻊ اﻟﻜﺎﻟﺴﻴﻮم ﻓﻲ اﻟﺠﺴﻢ‪:‬‬

‫ا===================‬
‫🔰‬
‫ﺑﺎﻟﻴﻮم ‪ :‬ﺗﻌﺘﺒﺮ ﻣﺸﺘﻘﺎت اﻷﻟﺒﺎن )اﻟﺤﻠﻴﺐ و اﻟﺠﺒﻦ( ﻣﺼﺎدر رﺋﻴﺴﻴﺔ ‪.‬‬

‫ﻳﺤﺘﻮي اﻟﺠﺴﻢ ﻋﻠﻰ ﺣﻮاﻟﻲ ﻣﺎ وزﻧﻪ ‪ 1.0-1.3‬ﻛﺠﻢ ﻣﻦ اﻟﻜﺎﻟﺴﻴﻮم ﻣﻮزﻋﺔ ﻛﺎﻟﺘﺎﻟﻲ‪:‬‬

‫‪ 99%‬ﻓﻲ اﻟﻌﻈﺎم‪.‬‬
‫‪ 1%‬ﺧﺎرج اﻟﻌﻈﺎم ﻓﻲ اﻟﺪورة اﻟﺪﻣﻮﻳﺔ‪.‬‬
‫اﻟﻜﻤﻴﺔ اﻟﻤﺘﻮاﺟﺪة ﻓﻲ اﻟﻌﻈﺎم )‪ (99%‬ﺗﺘﻮاﺟﺪ ﻋﻠﻰ ﺷﻜﻠﻴﻦ ‪:‬‬
‫‪ 99% 1‬ﻣﻨﻬﺎ ﻋﻠﻰ ﺷﻜﻞ ﻣﻌّﻘﺪ ﻣﻌﺪﻧﻲ ﺑّﻠﻮري ﻣﺘﺤﺪ ﻣﻊ اﻟﻔﻮﺳﻔﺎت ﻳﺴﻤﻰ ‪) hydroxyapatite‬‬
‫ﺗﺸّﻜﻞ ‪ 70%‬ﻣﻦ وزن اﻟﻌﻈﺎم ( ﻳﺴﺘﺨﺪم ﻟﺘﻜﻮﻳﻦ اﻟﻌﻈﺎم وإﻋﻄﺎﺋﻪ اﻟﺼﻼﺑﺔ اﻟﻤﻌﺮوﻓﺔ‪ ،‬ﻛﻤﺎ ﻳﺴﺘﺨﺪم ﻫﺬا‬
‫⃣‬
‫اﻟﻤﻌّﻘﺪ ﻛﻤﺨﺰون ﻟﺘﺰوﻳﺪ اﻟﻨﻘﺺ "ﻃﻮﻳﻞ اﻟﻤﺪى "‪ long-term‬ﻟﻜﺎﻟﺴﻴﻮم وﻓﻮﺳﻔﺎت اﻟﺪورة اﻟﺪﻣﻮﻳﺔ ) أي‬
‫ﻓﻲ ﺣﺎل ﻛﺎن ﻧﻘﺼﻬﻤﺎ ﻓﻲ اﻟﺪم ﻣﺴﺘﻤﺮ ﻟﻔﺘﺮات ﻃﻮﻳﻠﺔ ﻛﺨﻠﻞ ﻓﻲ اﻣﺘﺼﺎﺻﻬﻤﺎ ﻣﻦ اﻻﻣﻌﺎء ﺳﻮاء ﻛﺎن ﻧﺎﺗﺞ‬
‫ﻋﻦ ﺳﻮء اﻟﺘﺰّود اﻟﺨﺎرﺟﻲ او أي ﺳﺒﺐ اﺧﺮ ﻛﺨﻠﻞ ﻓﻲ "ﻓﻴﺘﺎﻣﻴﻦ د" او ﻓﺸﻞ ﻛﻠﻮي‪...‬اﻟﺦ (‪ .‬ﺗﺤﺮﻳﺮ ﻣﻌّﻘﺪ‬
‫اﻟﻜﺎﻟﺴﻴﻮم واﻟﻔﻮﺳﻔﺎت اﻟﻤﻜّﻮن ﻟﻠﻌﻈﺎم ﻳﺤﺘﺎج ﻣﻦ اﻟﺨﻼﻳﺎ اﻟﻬﺎدﻣﺔ ﻟﻠﻌﻈﺎم ﻣﻦ اﻳﺎم اﻟﻰ ﺷﻬﻮر ﻟﻜﻲ ﻳﺘﺤﺮر‬

‫‪ 2‬ﻋﻠﻰ ﺷﻜﻞ ﻛﺎﻟﺴﻴﻮم ﺣﺮ ) و اﻳﻀﺎ اﻟﻔﻮﺳﻔﺎت ﻳﻜﻮن ﺣﺮ( ﻓﻲ ﻣﺎ ﺑﻴﻦ ﺧﻼﻳﺎ اﻟﻌﻈﺎم )‬ ‫⃣‬
‫ﺑﺴﺒﺐ ﻗﻮﺗﻪ وﺻﻼﺑﺘﻪ‪ .‬واذا اﺳﺘﻤﺮت ﻋﻤﻠﻴﺔ اﻟﺘﺤﺮﻳﺮ ﻟﻔﺘﺮات ﻃﻮﻳﻠﺔ ﺗﺆدي اﻟﻰ ﺿﻌﻒ اﻟﻌﻈﺎم‪.‬‬
‫‪1%‬‬
‫اﻟﻤﺎﺗﺮﻛﺲ (‪ ،‬ﺗﺴﺘﺨﺪم ﻟﻠﺘﺒﺎدل اﻟﺴﺮﻳﻊ "ﻗﺼﻴﺮ اﻟﻤﺪى "‪ short-term‬ﻣﻊ اﻟﺪورة اﻟﺪﻣﻮﻳﺔ‪.‬‬
‫اﻟﻜﻤﻴﺔ اﻟﻤﺘﻮاﺟﺪة ﻓﻲ اﻟﺪم )‪ (1%‬ﺗﺘﻮاﺟﺪ ﻋﻠﻰ ﺛﻼﺛﺔ اﺷﻜﺎل ‪:‬‬
‫‪ 1‬ﻛﺎﻟﺴﻴﻮم ﻣﺘﺄﻳﻦ ﺣﺮ وﻫﻮ اﻟﻨﺸﻂ ﺑﻴﻮﻟﻮﺟﻴًﺎ‪.‬‬ ‫⃣‬
‫⃣‬ ‫‪50%‬‬
‫‪ 2‬ﻣﺮﺗﺒﻄﺔ ﺑﺎﻟﺒﺮوﺗﻴﻨﺎت واﻫﻤﻬﺎ اﻻﻟﺒﻴﻮﻣﻴﻦ‪.‬‬

‫⛔‬
‫‪ 3‬ﻣﺮﺗﺒﻄﺔ ﺑﺄﻳﻮﻧﺎت اﺧﺮى ﻛﺎﻟﻔﻮﺳﻔﺎت واﻟﻼﻛﺘﺎت واﻟﺴﺘﺮات واﻟﺒﻴﻮﻛﺎرﺑﻮﻧﺎت‪...‬اﻟﺦ‪.‬‬
‫& ‪PTH by calcium of Regulations Short-term‬‬ ‫‪Long-term‬‬
‫⃣‬ ‫‪40%‬‬
‫‪10%‬‬

‫ﺴﺎس ﺻﺎرم و ﺳﺮﻳﻊ‪ ،‬ﻳﺨﻀﻊ ﻟﻪ ﻛﺎﻟﺴﻴﻮم اﻟﺪم ﻟﻴﻈﻞ ﻓﻲ ﻣﺴﺘﻮاه اﻟﻄﺒﻴﻌﻲ دون اﺿﻄﺮاب ﺑﺰﻳﺎدٍة‬ ‫ﻧﻈﺎم ﺣ ّ‬
‫او ﻧﻘﺼﺎن‪.‬‬
‫ﻧﻈﺎم ﻳﺒﻠﻎ ﻣﻦ اﻟﺴﺮﻋﺔ ان ﻳﻌﻴﺪ ﻣﺴﺘﻮى اﻟﻜﺎﻟﺴﻴﻮم اﻟﻰ ﻃﺒﻴﻌﺘﻪ ﺧﻼل دﻗﺎﺋﻖ ﻣﻌﺪودة‪ ،‬ﻓﻲ ﺣﺎل ﺣﺪوث‬

‫🤔‬
‫ﺧﻠﻞ ﻣﻔﺎﺟﺊ ﻓﻲ ﺗﺮﻛﻴﺰه‪!! ..‬‬
‫ﻟﻤﺎذا ﻫﺬه اﻟﺼﺮاﻣﺔ واﻟﺴﺮﻋﺔ ﻓﻲ ﺗﺄدﻳﺔ اﻟﻌﻤﻞ؟ ﻣﺎﻟﺬي ﻳﺘﻤّﻴﺰ ﺑﻪ اﻟﻜﺎﻟﺴﻴﻮم ﻋﻦ ﻏﻴﺮه ﻣﻦ اﻟﻌﻨﺎﺻﺮ‬
‫واﻟﻤﺮﻛﺒﺎت اﻟﻤﻮﺟﻮدة ﻓﻲ ﺟﺴﻢ اﻻﻧﺴﺎن‪ ،‬ﻟﻴﺤﻈﻰ ﺑﻤﺜﻞ ﻫﺬا اﻟﺘﻨﻈﻴﻢ ﺷﺪﻳﺪ اﻟﺪﻗﺔ واﻟﺴﺮﻋﺔ؟!… ‪.‬‬
‫ﻻ ﺗﻜﺎد ﺗﺠﺪ ﻋﻤﻠﻴﺔ ﺣﻴﻮﻳﺔ ﻓﻲ اﻟﺠﺴﺪ اﻟﺒﺸﺮي‪ ،‬ﻣﻦ ﺑﻴﻦ ﻋﺸﺮات ورﺑﻤﺎ ﻣﺌﺎت اﻟﻌﻤﻠﻴﺎت اﻟﺠﺎرﻳﺔ ﻋﻠﻰ‬
‫ﻗﺪٍم وﺳﺎق ﻓﻲ ﻛﻞ ﺛﺎﻧﻴﺔ وﻛﻞ دﻗﻴﻘﺔ‪ ،‬ﻻ ﺗﻌﺘﻤﺪ ﻓﻲ ﻋﻤﻠﻬﺎ‪ ،‬ﺑﻄﺮﻳﻘﺔ او ﺑﺄﺧﺮى‪ ،‬ﻋﻠﻰ اﻳﻮن اﻟﻜﺎﻟﺴﻴﻮم…‬
‫👌‬
‫ﻓﻬﻮ ﻳﺪﺧﻞ ﻓﻲ ﺟﻤﻴﻊ اﻟﻌﻤﻠﻴﺎت اﻟﻔﺴﻴﻮﻟﻮﺟﻴﺔ ﻓﻲ ﺟﺴﻢ اﻻﻧﺴﺎن ﺗﻘﺮﻳﺒًﺎ‪...‬‬
‫‪Metabolism: Phosphorus & Calcium , Parathyroids the of Disorders‬‬
‫==============================‬
‫اﻧﻪ ﻟﻤﻦ اﻟﺼﻌﻮﺑﺔ ان ﺗﺠﺪ ﻋﻤﻠﻴﺔ ﻓﺴﻴﻮﻟﻮﺟﻴﺔ ﻓﻲ ﺟﺴﻢ اﻻﻧﺴﺎن ﻻ ﺗﻌﺘﻤﺪ‪ ،‬ﺑﻄﺮﻳﻘﺔ او ﺑﺎﺧﺮى‪ ،‬ﻋﻠﻰ‬
‫اﻳﻮن اﻟﻜﺎﻟﺴﻴﻮم‪ .‬ﻓﺈﻧﺤﺮاف ﻣﺴﺘﻮاه ﻋﻦ اﻟﻤﺴﺘﻮى اﻟﻄﺒﻴﻌﻲ‪ ،‬زﻳﺎدًة او ﻧﻘﺼﺎﻧًﺎ‪ ،‬ﻓﻲ اﻟﺪم ﻳﺆدي اﻟﻰ ﻋﻮاﻗﺐ‬
‫🔰‬
‫وﺧﻴﻤﺔ‪ ،‬ﻛﺎﻹﺛﺎرة اﻟﻌﻀﻠﻴﺔ اﻟﻌﺼﺒﻴﺔ وﻧﻮﺑﺔ اﻟﺘﺸﻨﺞ اﻟﻌﻀﻠﻲ و ﺗﺸﻨﺞ اﻟﻌﻀﻼت اﻟﻤﺴﺘﻤﺮ ﻓﻲ ﺣﺎﻟﺔ ﻧﻘﺼﺎﻧﻪ‪..‬‬
‫وﻓﻲ ﺣﺎل زﻳﺎدﺗﻪ‪ :‬ﺣﺼﻮات ﻛﻠﻮﻳﺔ‪ ،‬ﺗﺄﺧﺮ او ﺗﺒﺎﻃﺆ ردود اﻻﻓﻌﺎل ) زﻳﺎدة اﻟﻜﺎﻟﺴﻴﻮم ﻳﻘﻠﻞ ﻣﻦ ﻧﻔﺎذﻳﺔ‬
‫اﻻﻏﺸﻴﺔ اﻟﻌﺼﺒﻴﺔ ﻟﻠﺼﻮدﻳﻮم (‪ ،‬ﻓﻘﺪان اﻟﺸﻬﻴﺔ‪ ،‬اﻻﻣﺴﺎك‪ ،‬اﺿﻄﺮاب ُﻧﻈﻢ اﻟﻘﻠﺐ‪ ،‬ﺗﻌُّﺮض او ﻗﺎﺑﻠﻴﺔ اﻟﻌﻈﺎم‬
‫ﻟﻠﻜﺴﺮ ) ﻓﻲ ﺣﺎل ﻛﺎن زﻳﺎدة ﻛﺎﻟﺴﻴﻮم اﻟﺪم ﻧﺎﺗﺞ ﻣﻦ اﺧﺮاﺟﻪ ﻣﻦ اﻟﻌﻈﺎم(‪....‬اﻟﺦ‪.‬‬
‫ﻟﺬﻟﻚ ﻳﺠﺐ اﻟﻤﺤﺎﻓﻈﺔ ﻋﻠﻰ ﻣﺴﺘﻮاه اﻟﻄﺒﻴﻌﻲ ﺑﺸّﺪة وﺑﺎﻟﺴﺮﻋﺔ اﻟﻤﻨﺎﺳﺒﺔ؛ ﺗﺠﻨﺒُﺎ ﻷﻳﺔ ﻣﺸﺎﻛﻞ ﻗﺪ ﺗﻨﺘﺞ ﻋﻦ‬
‫اﺿﻄﺮاب ﻓﻲ ﺗﺮﻛﻴﺰه‪.‬‬

‫‪Calcium of Regulaion‬‬

‫اﻋﺪاد ﻋﺒﺪاﻟﻤﻠﻚ اﻟﺤﺎرﺛﻲ‬

 ‫ا===========================‬
‫ﺴﺎﺳﺔ ﻟﻠﻜﺎﻟﺴﻴﻮم ) اﻟﻤﺘﺄﻳﻦ ‪ -‬اﻟﺤﺮ ( ﺗﺴﻤﻰ‪Calcium:‬‬
‫ﺗﺤﺘﻮي ﺧﻼﻳﺎ اﻟﻐﺪة اﻟﺠﺎردرﻗﻴﺔ ﻋﻠﻰ ﻣﺴﺘﻘﺒﻼت ﺣ ّ‬
‫‪CaRs) )Receptors sensing-‬‬
‫🔰‬
‫وارﺗﺒﺎط اﻟﻜﺎﻟﺴﻴﻮم ﻟﻬﺬه اﻟﻤﺴﺘﻘﺒﻼت ‪ -‬ﻓﻲ ﺣﺎل ﻛﺎن اﻟﻤﺴﺘﻮى ﻣﺮﺗﻔﻌًﺎ ‪ -‬ﻳﻌﻤﻞ ﻋﻠﻰ اﻃﻼق اﺷﺎرة داﺧﻞ‬
‫ﺧﻠﻮﻳﺔ ﺗﻌﻤﻞ ﻋﻠﻰ اﻟﺘﺜﺒﻴﻂ ﻣﻦ اﻓﺮاز ﻫﺮﻣﻮن الـ‪ .PTH‬واﻟﻌﻜﺲ ﻳﺤﺪث‪ :‬ﻋﻨﺪﻣﺎ ﻳﻘﻞ ﺗﺮﻛﻴﺰ اﻟﻜﺎﻟﺴﻴﻮم‬
‫ﻓﻲ اﻟﺪم‪ ،‬ﻓﺈن ﻫﺬه اﻟﻤﺴﺘﻘﺒﻼت ﺗﺘﺤﺴﺲ ﻟﻬﺬا اﻟﻨﻘﺺ‪ ،‬ﻓﺘﻌﻄﻲ اﺷﺎرة داﺧﻞ ﺧﻠﻮﻳﺔ ﺗﻌﻤﻞ ﻋﻠﻰ ﺗﻨﺸﻴﻂ‬
‫اﻓﺮاز اﻟﻬﺮﻣﻮن‪ .‬و ﻧﻈﺮًا ﻟﻼﻫﻤﻴﺔ اﻟﻔﺴﻴﻮﻟﻮﺟﻴﺔ اﻟﻤﻬﻤﺔ لـ اﻳﻮن اﻟﻜﺎﻟﺴﻴﻮم؛ ﺗﺴﺘﺠﻴﺐ اﻟﻐﺪة اﻟﺠﺎردرﻗﻴﺔ‬
‫ن ﻣﻌﺪودة ﻣﻦ ﺗﺤﺴﺴﻬﺎ ﻟﻬﺒﻮط ﻣﺴﺘﻮى اﻟﻜﺎﻟﺴﻴﻮم‪ ،‬وﺗﻌﻤﻞ ﻋﻠﻰ اﻟﻤﺤﺎﻓﻈﺔ‬ ‫ﻹﻓﺮاز ﻫﺮﻣﻮﻧﻬﺎ ﻓﻲ ﺧﻼل ﺛﻮا ٍ‬
‫اﻟﺜﺎﺑﺘﺔ ﻟﻤﺴﺘﻮاه ﻓﻲ ﺧﻼل دﻗﺎﺋﻖ ﻣﻌﺪودة ﻓﻲ اﻟﺸﺨﺺ اﻟﻄﺒﻴﻌﻲ ‪ -‬اﻟﺬي ﻻ ﻳﻌﺎﻧﻲ ﻣﻦ ﻣﺸﺎﻛﻞ ﻛﻠﻮﻳﺔ ‪-‬‬
‫ﻫﺬه اﻻﺳﺘﺠﺎﺑﺔ ﻣﺬﻫﻠﺔ اﻟﺴﺮﻋﺔ‪ ،‬ﺗﺄﺗﻲ ﻣﻦ اﻟﺤﻘﻴﻘﺔ اﻟﻌﻠﻤﻴﺔ اﻟﻄﺒﻴﺔ اﻟﺘﻲ ﺗﻘﻮل‪ :‬اﻧﻬﺎ ﻟﻤﻦ اﻟﺼﻌﻮﺑﺔ ان ﺗﺠﺪ‬
‫ﻋﻤﻠﻴﺔ ﻓﺴﻴﻮﻟﻮﺟﻴﺔ ﻓﻲ ﺟﺴﻢ اﻻﻧﺴﺎن ﻻ ﺗﻌﺘﻤﺪ‪ ،‬ﺑﻄﺮﻳﻘﺔ او ﺑﺄﺧﺮى‪ ،‬ﻋﻠﻰ اﻳﻮن اﻟﻜﺎﻟﺴﻴﻮم‪.‬‬
‫ﻳﻨﻄﻠﻖ ﻫﺮﻣﻮن الـ‪ PTH‬ﻣﻦ اﻟﻐﺪة اﻟﺠﺎردرﻗﻴﺔ اﻟﻰ اﻟﺪم ﻋﻨﺪﻣﺎ ﺗﺘﺤﺴﺲ ﻣﺴﺘﻘﺒﻼﺗﻬًﺎ ﻟﻨﻘﺺ‬
‫اﻟﻜﺎﻟﺴﻴﻮم‪ ،‬وﻳﻌﻤﻞ ﻋﻠﻰ إﻋﺎدة اﻟﻜﺎﻟﺴﻴﻮم اﻟﻰ ﻣﺴﺘﻮاه اﻟﻄﺒﻴﻌﻲ اﻟﻀّﻴﻖ ﺑﺘﺄﺛﻴﺮه ﻋﻠﻰ ﻣﻨﻄﻘﺘﻴﻦ‪ ...‬اﻟﻌﻈﺎم‬
‫🔰‬
‫واﻟﻜﻠﻴﺘﻴﻦ‪.‬‬
‫وﻳﺠﺐ ان ﻧﻌﺮف ان ﻋﻤﻞ اﻟﻬﺮﻣﻮن ﻓﻲ ﻫﺬه اﻟﻤﻨﻄﻘﺘﻴﻦ ﻟﻴﺲ ﻣﻨﻔﺼﻼ‪ ،‬واﻧﻤﺎ ﻣﺘﺰاﻣﻨًﺎ ﻓﻲ ﻧﻔﺲ اﻟﻮﻗﺖ‪.‬‬
‫‪:kidney and bone on PTH of Action‬‬
‫=========================‬

‫‪:bone on actions indirect and direct both has 1‬‬ ‫⃣‬ ‫‪PTH‬‬
‫)‪an cause to and osteoblasts on directly acts PTH ,transiently and Initially(1‬‬
‫‪.formation bone in increase‬‬
‫)‪,osteoblasts from release cytokines PTH ,action indirect ,second a In (2‬‬
‫‪effect bone the ,Alone .osteoclasts by resorption bone stimulate which‬‬
‫‪with Ca of complexation of because ,?? Ca plasma elevate not would‬‬
‫‪inhibit to kidney on PTH of action coordinated the ,Importantly .phosphate‬‬
‫‪the of elimination and phosphaturia causing ,reabsorption phosphate‬‬
‫‪,phosphate plasma in fall consequent a ,bone from resorbed phosphate‬‬
‫‪reabsorption Ca tubular renal increases PTH ,Also .rise to Ca plasma allows‬‬
‫‪in rise the to contributing and fluid extracellular the to Ca more providing‬‬
‫‪⤵.concentration Ca plasma‬‬
‫‪increasing by absorption calcium intestinal enhancing Indirectly 2‬‬
‫‪D. vitamin 1,25(OH)2 metabolite D vitamin active the of production renal the‬‬
‫⃣‬ ‫‪PTH‬‬

‫ﺷﺮح ﺗﻮﺿﻴﺤﻲ ﺑﺴﻴﻂ‪:‬‬

‫ا==============‬
‫ﻓﻲ اﻟﻌﻈﺎم ﺗﺘﻮاﺟﺪ ﺧﻼﻳﺎ ﺑﺎﻧﻴﺔ ﻟﻠﻠﻌﻈﺎم ﺗﺴﻤﻰ ‪ osteoblasts،‬وﺧﻼﻳﺎ ﻫﺎدﻣﺔ ﻟﻪ ﺗﺴﻤﻰ‬
‫‪osteoclasts..‬‬
‫ﺗﺘﻮاﺟﺪ ﻣﺴﺘﻘﺒﻼت الـ‪ PTH‬ﻋﻠﻰ اﻟﺨﻼﻳﺎ اﻟﺒﺎﻧﻴﺔ وﻻ ﺗﺘﻮاﺟﺪ ﻋﻠﻰ اﻟﺨﻼﻳﺎ اﻟﻬﺎدﻣﺔ‪ .‬وﻋﻨﺪﻣﺎ ﻳﻔﺮز‬
‫اﻟﻬﺮﻣﻮن اﺳﺘﺠﺎﺑﺔ ﻟﻨﻘﺺ اﻟﻜﺎﻟﺴﻴﻮم وﻳﺬﻫﺐ اﻟﻰ ﻟﻌﻈﺎم وﻳﺮﺗﺒﻂ ﻟﻤﺴﺘﻘﺒﻼﺗﻪ ﻋﻠﻰ اﻟﺨﻼﻳﺎ اﻟﺒﺎﻧﻴﺔ‪ ،‬ﻳﺰﻳﺪ‬
‫ﻣﻦ ﺗﻜﺎﺛﺮﻫﺎ ﻓﺘﻌﻤﻞ ﻋﻠﻰ اﺧﺮاج اﻟﻜﺎﻟﺴﻴﻮم واﻟﻔﻮﺳﻔﺎت اﻟﺤّﺮﻳﻦ ﻣﻦ اﻟﻌﻈﺎم اﻟﻰ اﻟﺪم ﻛﺈﺟﺮاء وﻗﺎﺋﻲ‬
‫ﺳﺮﻳﻊ ﻟﺘﺰوﻳﺪ اﻟﺪورة اﻟﺪﻣﻮﻳﺔ ﺑﻬﻤﺎ← "ﺗﺄﺛﺮ اﻟﻬﺮﻣﻮن اﻟﻤﺒﺎﺷﺮ ﻋﻠﻰ اﻟﻌﻈﺎم"‪.‬‬
‫ﻛﻤﺎ ﺗﻔﺮز اﻟﺨﻼﻳﺎ اﻟﺒﺎﻧﻴﺔ ﻟﻠﻌﻈﺎم اﻳﻀﺎ ‪cytokines‬‬
‫واﻟﺘﻲ ﺗﺤﻔﺰ اﻟﺨﻼﻳﺎ اﻟﻬﺎدﻣﺔ ﻟﻠﻌﻈﺎم ﻟﻬﺪﻣﻪ واﺧﺮاج ﻣﻌّﻘﺪ اﻟﻜﺎﻟﺴﻴﻮم‪-‬اﻟﻔﻮﺳﻔﺎت واﻃﻼﻗﻪ اﻟﻰ اﻟﺪم ←"‬
‫ﺗﺈﺛﻴﺮ اﻟﻬﺮﻣﻮن ﻏﻴﺮ اﻟﻤﺒﺎﺷﺮ ﻟﻠﻌﻈﺎم"‪.‬‬

‫ﻫﺬا اﻟﻌﻤﻞ ﻟﻠﻬﺮﻣﻮن ﻋﻠﻰ اﻟﻌﻈﺎم ﻟﻮﺣﺪِه‪ ،‬ﻻ ﻳﺮﻓﻊ ﻣﻦ ﻣﺴﺘﻮى ﻛﺎﻟﺴﻴﻮم اﻟﺪم ﻣﺎﻟﻢ ﻳﻜﻦ اﻟﻬﺮﻣﻮن ‪-‬وﺑﻨﻔﺲ‬
‫اﻟﻮﻗﺖ‪ -‬ﻳﺆدي ﻋﻤﻼ ً آﺧﺮ ﻋﻠﻰ اﻟﻜﻠﻴﺘﻴﻦ‪ ،‬ﺑﺤّﺜﻬﺎ ﻋﻠﻰ إﻋﺎدة اﻣﺘﺼﺎص اﻟﻜﺎﻟﺴﻴﻮم وﻃﺮد اﻟﻔﻮﺳﻔﺎت ﻋﺒﺮ‬
‫اﻟﺒﻮل؟؟؟ ﻟﻤﺎذا ﻫﺬه اﻟﻌﻤﻠﻴﺔ ﻣﻦ ﻣﻨﻊ اﺣﺪﻫﻤﺎ وﻃﺮد اﻵﺧﺮ؟؟‬

‫ن ﻧﺴﺒﺔ ﻣﻨﻬﻤﺎ ﻳﻜﻮﻧﺎن ﻋﻠﻰ‬

‫ﻟﻌﻠﻜﻢ ﺗﻌﺮﻓﻮن اﻟﻌﻼﻗﺔ ﻣﺎ ﺑﻴﻦ اﻟﻜﺎﻟﺴﻴﻮم واﻟﻔﻮﺳﻔﺎت ﻓﻲ اﻟﺪورة اﻟﺪﻣﻮﻳﺔ ‪ ،‬وا ّ‬

‫اﻋﺪاد ﻋﺒﺪاﻟﻤﻠﻚ اﻟﺤﺎرﺛﻲ‬

 ‫ﺷﻜﻞ ﺣﺮ وﻧﺴﺒﺔ ﻳﻜﻮﻧﺎن ﻋﻠﻰ ﺷﻜﻞ إﺗﺤﺎد او ﻣﻌّﻘﺪ ﻣﻊ ﺑﻌﻀﻬﻤﺎ ﻓﻲ اﻟﺪم‪ .‬وﻫﺬا اﻻﺗﺤﺎد ﺑﻴﻨﻬﻤﺎ ﻳﻜﻮن‬
‫ﻣﺘﻮازﻧًﺎ – أي اﻧﻪ اذا ﻧﻘﺺ اﻟﺤﺮ ) اﻟﻨﺸﻂ ( ﻣﻦ اﺣﺪﻫﻤﺎ اﻧﻔﺼﻠﺖ ﻧﺴﺒﺔ ﻣﻨﻪ ﻣﻦ اﻟﻤﻌّﻘﺪ ﻟﺘﻌﻮﻳﺾ اﻟﻨﻘﺺ‬
‫وﺑﺎﻟﻤﻘﺎﺑﻞ ﻳﺘﺤﺮر اﻵﺧﺮ‪ .‬ﻓﻌﻨﺪﻣﺎ ﻳﺨﺮج اﻟﻜﺎﻟﺴﻴﻮم ) وﻣﻌﻪ اﻟﻔﻮﺳﻔﺎت ( ﻣﻦ اﻟﻌﻈﺎم ﻟﺘﻌﻮﻳﺾ ﻧﻘﺺ‬
‫ﻛﺎﻟﺴﻴﻮم اﻟﺪم ﻳﺨﺮج اﻟﺤﺮ واﻟﻤﻌّﻘﺪ‪ .‬ﻓﺎﻟﻜﺎﻟﺴﻴﻮم اﻟﺤﺮ ﻟﻮﺣﺪه ﻻ ﻳﺰﻳﺪ ﻣﻦ ﻧﻘﺼﺎن اﻟﻜﺎﻟﺴﻴﻮم اﻟﺤﺮ ﻓﻲ‬
‫اﻟﺪم ﺑﺎﻟﺸﻜﻞ اﻟﻤﻄﻠﻮب‪ ...‬واﻟﻜﺎﻟﺴﻴﻮم اﻟﻤﻌّﻘﺪ اﻟﺨﺎرج ﻣﻦ اﻟﻌﻈﺎم واﻟﻤﺮﺗﺒﻂ ﻣﻊ اﻟﻔﻮﺳﻔﺎت ﻻ ﻳﺴﺘﻔﺎد ﻣﻨﻪ‬
‫ﻟﺮﻓﻊ اﻟﻜﺎﻟﺴﻴﻮم اﻟﺤﺮ ﻓﻲ اﻟﺪم ﻻﻧﻪ ﻫﻨﺎ ﻳﻜﻮن ﻣﺮﺗﺒﻄﺎ وﻟﻴﺲ ﻟﻪ ﻧﺸﺎط‪ ،‬ﻓﻮﺟﻮده ﻛﻌﺪﻣﻪ‪ ..‬ﻓﻴﻌﻤﻞ اﻟﻬﺮﻣﻮن‬
‫ﻋﻠﻰ ﺣﺚ اﻟﻜﻠﻴﺘﻴﻦ ﻋﻠﻰ اﻋﺎدة اﻣﺘﺼﺎص اﻟﻜﺎﻟﺴﻴﻮم ﻣﻦ اﻟﺒﻮل ﻓﻴﺮﺗﻔﻊ ﻗﻠﻴﻼ ﻓﻲ اﻟﺪم‪ ،‬وﻋﻠﻰ ﻃﺮد‬
‫اﻟﻔﻮﺳﻔﺎت ﻣﻊ اﻟﺒﻮل ﻓﻴﺤﺼﻞ ﻧﻘﺺ ﻟﻠﻔﻮﺳﻔﺎت اﻟﺤﺮ ﻓﻲ اﻟﺪم‪ ..‬وﺑﺴﺒﺐ ﻧﻘﺼﺎن اﻟﻔﻮﺳﻔﺎت اﻟﺤﺮ ﻓﻲ اﻟﺪم‬
‫ﻳﺘﻢ ﺗﻌﻮﻳﺾ ﻫﺬا اﻟﻨﻘﺼﺎن ﻣﻦ اﻟﻔﻮﺳﻔﺎت ﺑﻔﺼﻞ ﻧﺴﺒﺔ ﻣﻨﻪ ﻋﻦ اﻟﻤﻌّﻘﺪ اﻟﻤﺘﺤﺪ ﻣﻊ اﻟﻜﺎﻟﺴﻴﻮم اﻟﺬي ﺗﻢ‬
‫اﺧﺮاﺟﻪ ﻣﻦ اﻟﻌﻈﺎم ﺑﻔﻌﻞ اﻟﺨﻼﻳﺎ اﻟﻬﺎدﻣﺔ‪ .‬اﻧﻔﺼﺎل اﻟﻔﻮﺳﻔﺎت ﻋﻦ ﻫﺬا اﻟﻤﻌّﻘﺪ ﻳﺘﺮك اﻟﻜﺎﻟﺴﻴﻮم ﺣﺮًا ﺑﻌﺪ‬
‫ان ﻛﺎن ﻣﺮﺗﺒﻄًﺎ ﻣﻌﻪ‪ ،‬ﻓُﻴﻀﺎف ﻫﺬا اﻟﻨﺎﺗﺞ اﻟﺠﺪﻳﺪ ﻣﻦ اﻟﻜﺎﻟﺴﻴﻮم اﻟﺤﺮ اﻟﻰ ﻛﺎﻟﺴﻴﻮم اﻟﺪورة اﻟﺪﻣﻮﻳﺔ ﻓﻴﺰﻳﺪ‬
‫ﻣﻦ ﺗﺮﻛﻴﺰه‪ ...‬وﻫﻜﺬا ﻳﻈﻞ اﻟﻌﻤﻞ‪ ...‬ﻳﺨﺮج اﻟﻤﻌﻘﺪ ﻣﻦ اﻟﻌﻈﺎم ﻓﻴﺘﻢ ﻃﺮد اﻟﻔﻮﺳﻔﺎت اﻟﺤﺮ ﻣﻦ اﻟﺪم ﻋﺒﺮ‬
‫اﻟﺒﻮل ﻟﻴﻨﻘﺺ ﺗﺮﻛﻴﺰه‪ ،‬ﻓﻴﺤﺼﻞ اﻧﻔﺼﺎل ﻟﻠﻔﻮﺳﻔﺎت ﻣﻦ اﻟﻤﻌﻘﺪ ﻟﻴﻌﻮض اﻟﻨﻘﺺ اﻟﻤﻄﺮود‪ ،‬ﺗﺎرﻛًﺎ اﻳﻮﻧﺎت‬
‫ﻛﺎﻟﺴﻴﻮم ﺣّﺮة ﺑﺈﻧﻔﺼﺎﻟﻪ ﻋﻨﻬﺎ‪ ،‬ﻓُﺘﻀﺎف ﻫﺬه اﻻﻳﻮﻧﺎت اﻟﻤﺘﺤﺮرة اﻟﻰ اﻟﻜﺎﻟﺴﻴﻮم اﻟﺤﺮ اﻟﻤﻮﺟﻮد ﻣﺴﺒﻘًﺎ ﻓﻲ‬
‫اﻟﺪم ﻓﻴﺮﺗﻔﻊ ﺗﺮﻛﻴﺰه‪.‬‬

‫ﻃﺒﻌًﺎ اذا اﺻﺒﺢ ﻣﺼﺪر ﻛﺎﻟﺴﻴﻮم اﻟﺪم اﻻﺳﺎﺳﻲ ﻫﻮ اﻟﻌﻈﺎم‪ ،‬ﺑﺴﺒﺐ ادى اﻟﻰ ﻧﻘﺼﺎن او ﺣﺮﻣﺎن اﻟﺪم ﻣﻦ‬
‫اﻟﻜﺎﻟﺴﻴﻮم ذو اﻟﻤﺼﺪر اﻟﺨﺎرﺟﻲ ﻛﻤﺎ ﻳﺤﺪث ﻓﻲ ﺣﺎل اﻟﻔﺸﻞ اﻟﻜﻠﻮي او ﻧﻘﺼﺎن "ﻓﻴﺘﺎﻣﻴﻦ دي" او ﺑﺴﺒﺐ‬
‫ﺧﻠﻞ ﻓﻲ اﻣﺘﺼﺎص اﻟﻜﺎﻟﺴﻴﻮم‪ ،‬ﻓﺈن اﺳﺘﻤﺮار ﺧﺮوج اﻟﻜﺎﻟﺴﻴﻮم ﻣﻦ اﻟﻌﻈﺎم ﻟﻔﺘﺮات ﻃﻮﻳﻠﺔ ﺗﺆدي اﻟﻰ‬
‫ﺿﻌﻔﻪ وﻫﺸﺎﺷﺘﻪ‪.‬‬

‫اﻟﺪور اﻟﺬي ﻳﻠﻌﺒﻪ اﻟﻌﻈﺎم ﺑﺮﻓﻊ ﻛﺎﻟﺴﻴﻮم اﻟﺪم ﻣﺎ ﻫﻮ اﻻ اﺟﺮاء ﺳﺮﻳﻊ ﻛﺤﺎﻟﺔ ﻃﻮارئ ﻳﺘﻢ ﺑﻪ ﺗﺰوﻳﺪ اﻟﺪم‬
‫ﺑﺎﻟﻜﺎﻟﺴﻴﻮم ﻓﻲ ﺧﻼل دﻗﺎﺋﻖ ﻣﻦ وﻗﺖ ﺗﺤﺴﺲ ﻣﺴﺘﻘﺒﻼت اﻟﻐﺪة اﻟﺠﺎردرﻗﻴﺔ ﻟﻠﻨﻘﺼﺎن‪ ،‬ﻷن اﻟﺪور اﻟﺬي‬
‫🔰‬
‫ﺗﻠﻌﺒﻪ اﻟﻜﻠﻴﺘﻴﻦ‪ ،‬ﺑﺘﻨﺸﻴﻄﻬﺎ لـ "ﻓﻴﺘﺎﻣﻴﻦ دي" ‪ ،‬واﻟﺬي ﺑﺪروه ﻳﻌﻤﻞ ﻋﻠﻰ اﻣﺘﺼﺎص اﻟﻜﺎﻟﺴﻴﻮم ﻣﻦ اﻻﻣﻌﺎء‪،‬‬
‫ﺑﺘﺤﻔﻴﺰه ﻟﺘﺼﻨﻴﻊ ﺑﺮوﺗﻴﻨﺎت راﺑﻄﺔ وﻧﺎﻗﻠﺔ ﻟﻠﻜﺎﻟﺴﻴﻮم‪ ،‬ﻳﺤﺘﺎج ﻣﻦ ‪ 24 – 12‬ﺳﺎﻋﺔ ﻟﻴﺒﺪأ ﻋﻤﻞ اﻻﻣﺘﺼﺎص‬
‫ﻣﻦ اﻻﻣﻌﺎء‪ .‬وﻷن اﻟﻜﺎﻟﺴﻴﻮم ﻣﻬﻢ‪ ،‬وﻳﺤﺘﺎج ﻟﻪ اﻟﺠﺴﻢ ﻓﻲ ﻛﻞ دﻗﻴﻘﺔ وﻛﻞ ﺛﺎﻧﻴﺔ‪ ،‬ﻛﺎن ﻻﺑﺪ ﻣﻦ ﻃﺮﻳﻘﺔ‬
‫إﺳﻌﺎﻓﻴﻪ ﻟﺘﺰوﻳﺪ اﻟﺠﺴﻢ ﺑﻪ‪ ،‬ﻋﻦ ﻃﺮﻳﻖ اﺧﺮاﺟﻪ ﻣﻦ ﻣﺎﺗﺮﻛﺲ اﻟﻌﻈﺎم اﻟﻰ اﻟﺪم وﻣﻨﻊ ﺧﺮوﺟﻪ ﻋﺒﺮ اﻟﺒﻮل‬
‫اﻟﻰ ان ﻳﺘﻢ اﻟﺘّﺰود ﺑﺎﻟﻜﺎﻟﺴﻴﻮم ﻣﻦ اﻻﻣﻌﺎء‪ .‬وﻋﻨﺪ اﻟﺘﺰّود ﻣﻦ اﻻﻣﻌﺎء وﺗﻌﺪﻳﻞ ﻣﺴﺘﻮى ﻛﺎﻟﺴﻴﻮم اﻟﺪم ﻳﺒﺪأ‬
‫ﺗﻠﻘﻴﻢ راﺟﻊ ﺳﻠﺒﻲ ﻋﻨﺪ ﺗﺤﺴﺲ ﻣﺴﺘﻘﺒﻼت اﻟﻐﺪة ﻟﻠﻜﺎﻟﺴﻴﻮم ﻓﻴﺘﻮﻗﻒ اﻓﺮاز اﻟﻬﺮﻣﻮن‪ ،‬وﻓﻲ ﺣﺎل ﻟﻢ ﻳﺘﻢ‬
‫اﻟﺘﺰّود ﻣﻦ اﻻﻣﻌﺎء ﻛﻌﻮز ﻓﻲ "ﻓﻴﺘﺎﻣﻴﻦ دي" او ﻓﺸﻞ اﻟﻜﻠﻴﺔ ﻓﻲ ﺗﻨﺸﻴﻄﻪ او ﺧﻠﻞ ﻓﻲ اﻻﻣﺘﺼﺎص‪ ،‬ﻳﺴﺘﻤﺮ‬
‫ﺸﻂ اﻟﺨﻼﻳﺎ اﻟﻬﺎدﻣﺔ ﻟﻠﻌﻈﺎم‪،‬‬
‫اﻓﺮاز اﻟﻬﺮﻣﻮن وﻳﺴﺘﻤﺮ ﺧﺮوج اﻟﻜﺎﻟﺴﻴﻮم ﻣﻦ ﻣﺎﺗﺮﻛﺲ اﻟﻌﻈﺎم‪ ،‬ﻛﻤﺎ ﺗﺘﻨ ّ‬
‫ﺑﺴﺒﺐ اﻟﺘﺤﻔﻴﺰ اﻟﻤﺴﺘﻤﺮ ﻟﻠﺨﻼﻳﺎ اﻟﺒﺎﻧﻴﺔ‪ ،‬ﻓﺘﺨﺮﺟﻪ ﻣﻨﻪ‪ ،‬وﻣﻊ اﻟﻮﻗﺖ ﻳﺼﺎب اﻟﻌﻈﺎم ﺑﺎﻟﻬﺸﺎﺷﺔ‪.‬‬

‫اﻟﻌﻤﻠﻴﺔ اﻟﻐﻴﺮ ﻣﺒﺎﺷﺮة ﻟﻞـ‪ PTH‬ﻫﻲ ﺑﺘﺤﻔﻴﺰ ﻫﺮﻣﻮن اﻟﺠﺎﻟﺮدرﻗﻴﺔ ﻟﻺﻧﺰﻳﻢ اﻟﻜﻠﻮي‬
‫∝‪ hydroxlase 1-‬اﻟﺬي ﻳﺤّﻮل ﻓﻴﺘﺎﻣﻴﻦ دي اﻟﻐﻴﺮ ﻧﺸﻂ اﻟﻰ ﻓﻴﺘﺎﻣﻴﻦ دي ﻧﺸﻂ‪:‬‬

‫)‪(active) D vitamin 1,25(OH)2 → (inactive) D vitamin 25(OH‬‬

‫واﻟﺬي ﺑﺪوره ﻳﻌﻤﻞ ﻋﻠﻰ اﻣﺘﺼﺎص اﻟﻜﺎﻟﺴﻴﻮم ﻣﻦ اﻻﻣﻌﺎء ﻋﺒﺮ ﺗﺼﻨﻴﻊ اﻟﺒﺮوﺗﻴﻨﺎت اﻟﻨﺎﻗﻠﺔ ‪Calbinden.‬‬
‫ﻣﻠﺨﺺ‪:‬‬

‫ن ﻣﻦ ﺗﺤﺴﺲ اﻟﺠﺎردرﻗﻴﺔ ﻟﻨﻘﺺ اﻟﻜﺎﻟﺴﻴﻮم واﻟﻌﻤﻞ ﻋﻠﻰ ﺗﺜﺒﻴﺖ‬ ‫ﻳﻨﻄﻠﻖ الـ‪ PTH‬ﻓﻲ ﺧﻼل ﺛﻮا ٍ‬ ‫♦‬
‫ا====‬

‫ﻣﺴﺘﻮاه ﻓﻲ ﺧﻼل دﻗﺎﺋﻖ‪.‬‬

‫ﻋﻤﻞ اﻟﻬﺮﻣﻮن ﻋﻠﻰ اﻟﻌﻈﺎم‪:‬‬ ‫⃣♦‬
‫‪1‬ﺑﻄﺮﻳﻘﺔ ﻣﺒﺎﺷﺮه‪ :‬ﻋﺒﺮ اﺧﺮاج اﻟﻜﺎﻟﺴﻴﻮم ﻣﻦ ﻣﺎﺗﺮﻛﺲ اﻟﻌﻈﺎم‪.‬‬
‫‪2‬وﺑﻄﺮﻳﻘﺔ ﻏﻴﺮ ﻣﺒﺎﺷﺮة‪ :‬ﻋﺒﺮ ﺗﺤﻔﻴﺰ اﻟﺨﻼﻳﺎ اﻟﺒﺎﻧﻴﺔ واﻟﺘﻲ ﺑﺪورﻫﺎ ﺗﺤّﻔﺰ اﻟﺨﻼﻳﺎ اﻟﻬﺎدﻣﺔ ﻹﺧﺮاج‬
‫ﻣﻌﻘّﺪ اﻟﻜﺎﻟﺴﻴﻮم واﻟﻔﻮﺳﻔﺎت ﻣﻦ ﻫﻴﻜﻞ اﻟﻌﻈﺎم وﻟﻴﺲ ﻣﻦ اﻟﻤﺎﺗﺮﻛﺲ ‪ ) matrix‬ﻣﺎدة اﻟﻨﺴﻴﺞ اﻟﺒﻴﻦ‬
‫⃣‬
‫ﺧﻠﻮﻳﺔ (‪.‬‬

‫ﻋﻤﻞ اﻟﻬﺮﻣﻮن ﻋﻠﻰ اﻟﻜﻠﻴﺘﻴﻦ‪:‬‬

‫‪1‬ﻳﻌﻤﻞ اﻟﻬﺮﻣﻮن وﺑﻨﻔﺲ اﻟﻮﻗﺖ ﻋﻠﻰ إﻋﺎدة اﻣﺘﺼﺎص اﻟﻜﺎﻟﺴﻴﻮم ﻣﻦ اﻟﺒﻮل وﻃﺮد اﻟﻔﻮﺳﻔﺎت‬
‫⃣♦‬
‫اﻋﺪاد ﻋﺒﺪاﻟﻤﻠﻚ اﻟﺤﺎرﺛﻲ‬
 ‫)ﻋﻤﻠﻴﺔ ﻣﺒﺎﺷﺮة (‪.‬‬
‫‪2‬وﻋﻠﻰ اﻣﺘﺼﺎص اﻟﻜﺎﻟﺴﻴﻮم ﻣﻦ اﻻﻣﻌﺎء ﻋﻦ ﻃﺮﻳﻖ ﻓﻴﺘﺎﻣﻴﻦ دي ) ﻋﻤﻠﻴﺔ ﻏﻴﺮ ﻣﺒﺎﺷﺮة (‪.‬‬ ‫⃣‬
‫‪:Ca of regulation Short-term‬‬
‫ﺗﺤﺪث وﻣﻦ دون ﺗﺪﺧﻞ ﻫﺮﻣﻮﻧﻲ‪ ،‬وﻫﻲ ﺗﻨﻈﻴﻢ ﻟﻤﺴﺘﻮى ﻛﺎﻟﺴﻴﻮم اﻟﺪم ﻓﻲ ﺣﺎل زاد او ﻧﻘﺺ ﺑﺸﻜﻞ‬
‫ﻣﻔﺎﺟﻰ وﻟﻔﺘﺮة ﻗﺼﻴﺮة ﻛﺄن ﻳﺒﺘﻠﻊ اﻟﺸﺨﺺ ﻛﻤﻴﺔ ﻛﺒﻴﺮة ﻣﻦ اﻟﻜﺎﻟﺴﻴﻮم او ﻓﻘﺪﻫﺎ ﻓﻲ ﺣﺎل اﻻﺳﻬﺎل‪.‬‬
‫ﻳﺤﺪث ﺗﺒﺎدل ﺑﻴﻦ ﻛﺎﻟﺴﻴﻮم اﻟﺪم وﻛﺎﻟﺴﻴﻮم اﻟﻌﻈﺎم‪ :‬إﻣﺎ ﺑﺘﺮﺳﻴﺐ اﻟﺰاﺋﺪ ﻣﻨﻪ ﻓﻲ اﻟﻌﻈﺎم او اﺧﺮاﺟﻪ ﻣﻦ‬
‫ﻣﺎﺗﺮﻛﺲ اﻟﻌﻈﺎم ﻓﻲ ﺣﺎل اﻟﻨﻘﺼﺎن ﻓﻲ اﻟﺪم‪.‬‬
‫‪:Ca of regulation Long-term‬‬
‫ﺗﺤﺪث ﻓﻲ ﺣﺎل ﻧﻘﺼﺎن ﻛﺎﻟﺴﻴﻮم اﻟﺪم اﻟﻤﺴﺘﻤﺮ‪ ،‬وﺗﺤﺪث ﺑﺘﺪﺧﻞ ﻫﺮﻣﻮﻧﻲ ﻋﻠﻰ اﻟﻌﻈﺎم واﻟﻜﻠﻴﺘﻴﻦ‪-‬ﻓﻲ‬

‫🧑🏻 🔬‬
‫ﺣﺎل ﺳﻼﻣﺘﻬﺎ‪ ،‬ﻛﻤﺎ ﺷﺮﺣﻨﺎ ﺳﺎﺑﻘًﺎ ﻓﻲ اﻻﻋﻠﻰ‪..‬‬
‫اﻟﻌﻼﻗﺔ ﺑﻴﻦ اﻟﻜﺎﻟﺴﻴﻮم واﻷﻟﺒﻮﻣﻴﻦ ﻓﻲ اﻟﺪم ؟؟‬

‫😇أوﻻ ً ﺿﺮوري أن ﻧﻌﺮف أن ﺣﻮاﻟﻲ ‪ 99%‬ﻣﻦ اﻟﻜﺎﻟﺴﻴﻮم ﻓﻲ اﻟﺠﺴﻢ ﻓﻲ اﻟﻬﻴﻜﻞ اﻟﻌﻈﻤﻲ واﻷﺳﻨﺎن‬
‫واﻟﻤﺘﺒﻘﻲ ﺣﻮاﻟﻲ ‪ 1%‬ﻳﻮﺟﺪ ﻓﻲ اﻟﺪم ‪.‬‬

‫اﻟﻜﺎﻟﺴﻴﻮم ﻓﻲ اﻟﺪم ﻳﺘﻢ ﺗﻮزﻳﻌﻪ ﺑﻴﻦ ﻋﺪة أﺷﻜﺎل👇👇👇🩸‬

‫🔹ﺣﻮاﻟﻲ ‪ 45%‬ﻣﻦ ﻛﺎﻟﺴﻴﻮم اﻟﺪم ﻳﻜﻮن ﻣﺘﺄﻳﻦ ‪. Calcium Ionized‬‬
‫🔹وﻛﺬاﻟﻚ ‪ 40%‬ﻣﻦ ﻛﺎﻟﺴﻴﻮم اﻟﺪم ﻳﻜﻮن ﻣﺮﺗﺒﻂ ﺑﺒﺮوﺗﻴﻦ اﻷﻟﺒﻮﻣﻴﻦ ‪. albumin to bound‬‬
‫🔹اﻟﻤﺘﺒﻘﻲ ﺣﻮاﻟﻲ ‪ 15%‬ﻣﺮﺗﺒﻂ ﺑﺎﻷﻧﻴﻮﻧﺎت ‪. anions to bound‬‬

‫⃣ ‪1‬اﻟﺴﺆال اﻷول ‪ :‬ﻣﺎﻫﻲ اﻟﺤﺎﻻت اﻟﻤﺮﺿﻴﺔ اﻟﺘﻲ ﻳﻨﻘﺺ ﺑﻬﺎ اﻷﻟﺒﻮﻣﻴﻦ وﻳﺆﺛﺮ ﻋﻠﻰ ﻧﺘﻴﺠﺔ اﻟﻜﺎﻟﺴﻴﻮم‬

‫🤔اﻟﺠﻮاب👇🏻👇🏻‬
‫اﻟﻜﻠﻲ ؟‬

‫‪syndrome ▪Nephrotic‬‬
‫‪failure renal ▪Chronic‬‬
‫‪cirrhosis ▪Liver‬‬
‫‪disease liver ▪Chronic‬‬
‫‪▪Malnutrition‬‬
‫ﻛﻞ ﻫﺬه اﻟﺤﺎﻻت ﺗﺴﺒﺐ ﻧﻘﺺ أﻟﺒﻮﻣﻴﻦ اﻟﺪم وﻧﻘﺺ اﻷﻟﺒﻮﻣﻴﻦ ﻳﺆدي إﻟﻰ اﻧﺨﻔﺎض اﻟﻜﺎﻟﺴﻴﻮم‬ ‫〽‬
‫اﻟﻜﻠﻲ ) ﻳﺘﺄﺛﺮ اﻟﻜﺎﻟﺴﻴﻮم اﻟﻜﻠﻲ ﻓﻘﻂ ‪ ، only calcium total affected‬اﻟﻤﺘﺄﻳﻦ ﻻ ﻳﺘﺄﺛﺮ ‪Ionized‬‬
‫‪( affected not calcium‬‬

‫ﻛﻞ اﻧﺨﻔﺎض ‪1‬ﺟﻢ‪/‬دﻳﺴﻴﻠﺘﺮ ﻓﻲ ﺗﺮﻛﻴﺰ اﻷﻟﺒﻮﻣﻴﻦ ﻓﻲ اﻟﺪم ﺳﻴﺨﻔﺾ ﺗﺮﻛﻴﺰ اﻟﻜﺎﻟﺴﻴﻮم اﻟﻜﻠﻲ ﺑﺤﻮاﻟﻲ‬ ‫🔺‬
‫‪ 0.8‬ﻣﻠﻎ‪/‬دﻳﺴﻴﻠﺘﺮ دون اﻟﺘﺄﺛﻴﺮ ﻋﻠﻰ ﺗﺮﻛﻴﺰ اﻟﻜﺎﻟﺴﻴﻮم اﻟﻤﺘﺄﻳﻦ ‪.‬‬

‫⃣ ‪2‬اﻟﺴﺆال اﻟﺜﺎﻧﻲ ‪ :‬ﻫﻞ ﻧﻘﺺ اﻟﻜﺎﻟﺴﻴﻮم ﻓﻲ ﻫﺬه اﻟﺤﺎﻻت ﻳﺸﻴﺮ اﻻ ﻣﺸﺎﻛﻞ ﻓﻲ اﻟﻌﻈﺎم ؟؟‬
‫🏻‬ ‫🏻👇‬ ‫👇‬ ‫🤔اﻟﺠﻮاب‬
‫🏿ﻃﺒﻌًﺎ اﻟﺠﻮاب ﻻ وﻳﻌﺘﺒﺮ ﻧﻘﺺ اﻟﻜﺎﻟﺴﻴﻮم ﻧﻘﺾ ﻛﺎذب ﻓﻲ اﻷﺷﺨﺎص اﻟﻠﻰ ﻣﻌﻬﻢ ﻧﻘﺺ اﻷﻟﺒﻮﻣﻴﻦ ‪.‬‬ ‫👈‬
‫👈اﻟﺤﺎﻻت اﻟﻠﻰ ﻳﻨﻘﺺ ﺑﻬﺎ اﻟﻜﺎﻟﺴﻴﻮم ﻳﺘﻄﻠﺐ ﻣﻨﺎ ﻗﻴﺎس ﻣﺴﺘﻮى اﻷﻟﺒﻮﻣﻴﻦ ﻓﺈذا ﻛﺎن اﻷﻟﺒﻮﻣﻴﻦ ﻧﺎﻗﺺ‬
‫ﻧﻌﻤﻞ ﺗﺼﺤﻴﺢ ﻟﻠﻜﺎﻟﺴﻴﻮم ﻓﺈن ﻋﺎد إﻟﻰ ﻣﺴﺘﻮاه اﻟﻄﺒﻴﻌﻲ ﺑﻌﺪ اﻟﺘﺼﺤﻴﺢ ﻫﻨﺎ ﻳﻜﻮن ﻧﻘﺼﻪ ﻛﺎذب ‪false‬‬
‫‪ Hypocalcemia‬ﻧﺘﻴﺠﺔ ﻧﻘﺺ اﻷﻟﺒﻮﻣﻴﻦ وﻫﻨﺎ ﺗﻜﻮن اﻟﻤﺸﻜﻠﺔ ﻟﻴﺴﺖ ﻓﻲ اﻟﻌﻈﺎم‪ ...‬أﻣﺎ إذا ﻋﻤﻠﻨﺎ‬
‫ﺗﺼﺤﻴﺢ ﻟﻠﻜﺎﻟﺴﻴﻮم وﻻ زال ﻣﺴﺘﻮى اﻟﻜﺎﻟﺴﻴﻮم ﻧﺎﻗﺺ ﻫﻨﺎ ﺑﻨﺤﺚ ﻋﻦ اﻟﺴﺒﺐ اﻟﺜﺎﻧﻲ ﻟﻨﻘﺺ اﻟﻜﺎﻟﺴﻴﻮم‬
‫وﻗﺪ ﻳﻜﻮن ﻧﺘﻴﺠﻪ ﻣﺸﻜﻠﻪ ﻣﻦ اﻟﻌﻈﺎم ‪.‬‬

‫🤔 👇🏻👇🏻‬ ‫⃣‬
‫‪3‬اﻟﺴﺆال اﻟﺜﺎﻟﺚ ‪ :‬ﻛﻴﻒ اﻋﻤﻞ ﺗﺼﺤﻴﺢ ﻟﻨﺘﻴﺠﺔ اﻟﻜﺎﻟﺴﻴﻮم ﻋﻨﺪ ﻧﻘﺺ اﻷﻟﺒﻮﻣﻴﻦ ؟؟‬
‫اﻟﺠﻮاب‬

‫🏻‬‫🏻👇‬ ‫👇‬ ‫🔹ﺻﻴﻐﺔ اﻟﻜﺎﻟﺴﻴﻮم اﻟﻤﻌﺪﻟﺔ ﺑﺄﻟﺒﻮﻣﻴﻦ اﻟﺒﻼزﻣﺎ أو اﻟﻤﺼﺤﺤﺔ ﻫﻲ ﻛﻤﺎ ﻳﻠﻲ‪:‬‬
‫‪🅰 Ca Serum + ( Albumin patient - 4) × 0.8 = mg/dL Calcium Corrected‬‬
‫اﻋﺪاد ﻋﺒﺪاﻟﻤﻠﻚ اﻟﺤﺎرﺛﻲ‬
 ‫👇‬ ‫اﻟﺒﻌﺾ ﻳﺘﺴﺄل ﻣﻦ أﻳﻦ ﺟﺒﻨﺎ اﻟﺮﻗﻢ ‪ 0.8‬واﻟﺮﻗﻢ ‪ 4‬ﻓﻲ اﻟﻤﻌﺎدﻟﺔ !!‬
‫✏اﻟﺮﻗﻢ ‪ 0.8‬ﻣﻠﻎ‪/‬دﻳﺴﻴﻠﺘﺮ ﻫﻮ ﻛﻤﻴﺔ ﻧﻘﺺ اﻟﻜﺎﻟﺴﻴﻮم ﻷن ﻛﻞ اﻧﺨﻔﺎض ‪ 1‬ﺟﻢ‪/‬دﻳﺴﻴﻠﺘﺮ ﻣﻦ اﻷﻟﺒﻮﻣﻴﻦ‬
‫ﺳﻴﺨﻔﺾ ﺗﺮﻛﻴﺰ اﻟﻜﺎﻟﺴﻴﻮم اﻟﻜﻠﻲ ﺑﻨﺴﺒﺔ ‪. 0.8mg/dl‬‬
‫✏اﻟﺮﻗﻢ ‪ 4.0‬ﻫﻮ ﻣﺘﻮﺳﻂ ﻣﺴﺘﻮى اﻷﻟﺒﻮﻣﻴﻦ اﻟﻄﺒﻴﻌﻲ ‪.‬‬

‫🅱‬ ‫‪= mmol/L Calcium Corrected‬‬

‫‪Ca Serum + Albumin) patient - 40) × 0.02‬‬

‫👇🏻‬ ‫👇🏻‬ ‫أﻣﺜﻠﺔ ﺗﻄﺒﻴﻘﻴﺔ‬

‫اﻟﺤﺎﻟﺔ اﻷوﻟﻰ ‪ :‬ﻣﺮﻳﺾ ﻣﻌﻪ ﻧﺘﻴﺠﺔ اﻟﻜﺎﻟﺴﻴﻮم ﻋﻠﻰ اﻟﻨﺤﻮ اﻟﺘﺎﻟﻲ ‪:‬‬
‫🌐‬
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‫⭕‬
‫‪(10.5 — 8.5) mg/dl 7.3 ▪Calcium‬‬

‫)‪(5.5–3.5‬ﻛﺎﻧﺖ اﻟﻨﺘﻴﺠﺔ ﻛﺎﻟﺘﺎﻟﻲ ‪🏻👇:‬‬

‫وﺑﻌﺪ أن اﺿﻔﻨﺎ ﻟﻪ ﻓﺤﺺ اﻷﻟﺒﻮﻣﻴﻦ‬
‫‪g/dl 2.3 ▪Albumin‬‬

‫🤔اﻟﺴﺆال اﻵن اﻋﻤﻞ ﺗﺼﺤﻴﺢ ﻟﻨﺘﻴﺠﺔ اﻟﻜﺎﻟﺴﻴﻮم ؟؟؟‬

‫‪Ca Serum + ( Albumin patient - 4) × 0.8 = mg/dL Calcium ⚠ Corrected‬‬

‫‪mg/dl 8.66 = 7.3 + ( 2.3 - 4.0 ) × 0.8= calcium ✔Adjusted‬‬

‫⭕‬
‫👇🏻‬
‫اﻟﺤﺎﻟﺔ اﻟﺜﺎﻧﻴﺔ‪ :‬ﻣﺮﻳﺾ ﻳﻌﺎﻧﻲ ﻣﻦ ﺗﻠﻴﻒ ﻓﻲ اﻟﻜﺒﺪ وﻛﺎﻧﺖ ﺑﻌﺾ ﻧﺘﺎﺋﺞ اﻟﻜﻴﻤﻴﺎء ﻋﻠﻰ اﻟﻨﺤﻮ اﻟﺘﺎﻟﻲ ‪:‬‬

‫‪(2.55–2.15) mmol/L 1.81 ▪Calcium‬‬

‫‪(45–35) g/L 20 ▪Albumin‬‬

‫‪What‬ل ‪🤔calcium? albumin-adjusted the👇👇is‬‬

‫اﻟﺴﺆا‬

‫⚠ ‪Ca Serum + Albumin) patient - 40) × 0.02 = calcium‬‬ ‫‪Adjusted‬‬

‫‪. mmol/L 2.21 = 1.81 + ( 20 - 40 ) × 0.02 = calcium ✔Adjusted‬‬

‫ﻓﻲ ﻛﻼ اﻟﺤﺎﻟﺘﻴﻦ ﻧﻼﺣﻆ أن اﻟﻜﺎﻟﺴﻴﻮم ﺑﻌﺪ ﺗﺼﺤﻴﺤﻪ اﺻﺒﺢ ﺿﻤﻦ اﻟﻤﺴﺘﻮى اﻟﻄﺒﻴﻌﻲ وﻻ ﻳﺘﻄﻠﺐ‬ ‫〽‬
‫ﻋﻼﺟﺎ ﻣﺤﺪدا وﻟﺬاﻟﻚ ﻧﺘﺬﻛﺮ ﻫﺬا داﺋﻤًﺎ إذا ﻛﺎن اﻟﻤﺮﻳﺾ ﻳﻌﺎﻧﻲ ﻣﻦ ﻧﻘﺺ أﻟﺒﻮﻣﻴﻦ اﻟﺪم ‪.‬‬
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‫اﻋﺪاد ﻋﺒﺪاﻟﻤﻠﻚ اﻟﺤﺎرﺛﻲ‬