CALCIUM METABOLISM

Calcium is one of the essential minerals of our body.

The total calcium in human body is about 1 to 1.5 kg of
which 99% is in the bones and 1% is in the extra cellular
fluid.
Sources:
1. Cow’s milk is the best source. (100 mg per 100 ml )
2. Human milk ( 30 mg per 100 ml)
3. Other important sources are egg, fish, vegetables,
wheat
Daily requirements:
1. Children: 1200 mg/day
2. Adult: 500 to 1000 mg / day
3. Pregnancy and lactation: 1500 to 2000 mg / day

Absorption: Absorption takes place mainly in 1st

and 2nd part of duodenum. Vitamin D, PTH, acidosis,
amino acid (lysine and arginine) increases its
absorption. On the other hand, phytates, oxalates,
fat and phosphates, and malabsorption syndrome
decreases its absorption
 FUNCTIONS OF CALCIUM
1. Muscle contraction
2. Transmission of nerve impulse
3. Blood coagulation (factor IV)
4. Activation of various enzyme systems, e.g., Adenile cyclase,
etc.
5. Secretions of hormones, e.g., insulin, PTH, calcitonine, etc.
6. Calcium is also known as secondary messengers of different
hormones
7. It gives strength to bones and teeth
8. Calcium decreses permeability of serum through capillariesA
9. Calcium and calmodulin complex regulates degranulation of
secretory vesicles
10. Myocardium: calcium prolongs systole
Fig: calcium homeostasis
BLOOD LEVEL OF CALCIUM (9-11)
mg %

Range: highest range: 8.8 – 10.4 mg%

Lowest range: 2.2 – 2.6 mg%
(10 ml% = 5 mEq/L = 2.5 m mols/L)
Clacium remains in three forms in blood:
1. Ionised form = 5 mg %
2. Complex and as anions = 1 mg %
3. Bound to blood protein = 4 mg % (non-
diffusable)
 CALCITRIOL ( active form of vitamin
D)
1. Intestinal villi cells: it promotes calcium and phosphate
absorption.
Lumen to villi (passive process)
villi to blood (active process)
Sodium and calcium exchange mechanism or cacium
calmodulin complex
2. Bone: increases osteoblastic activities by secreting alkaline
phosphatase.
Local concentration of phosphate increases leading to
increased production of alcium and phosphate
(mineralisation of bones)
3. Renal tubules: it increases absorption of calcium and
phosphate by distal convulated tubules.
 FACTORS REGULATING BLOOD
CALCIUM LEVEL
1. Calcitriol
2. PTH: it increases serum calcium level
3. Calcitonin: it decreases reabsorption of bones
4. Phosphate: calcium is to phosphate = 2.5 is to 1
5. Serum protein: when serum level is decreased calcium
level is also decreased
6. Alkalosis: makes calcium bound more with protein
leading to decreases in the ionised fraction of calcium.
Calcium starts excreting in urine when serum calcium
level is more than 10 mg/dL (kidney threshold)
 HYPERCALCEMIA
It is defined as a condition where the level of calcium in the
blood is more than 11 mg%
Causes:
1. Hyperparathyroidism (adenoma, ectopic PTH, secretory
tumour)
2. Multiple myeloma
3. Paget’s disease of bone
4. Metastatic carcinoma of bone
5. Milk-alkali syndrome
6. Vitamin D toxicity
7. Lithium therapy
8. Thiazide dieuretics
 Symptoms:
Anorexia, muscle weakness, short ST interval
ECG, ectopic calcification in renal tubules,
pancreas, arterial walls, muscle tissues, etc.

Treatment:
Treatment of the cause.
 HYPOCALCEMIA
When the serum calcium level is less than 8.8 mg/dL
When the serum calcium level falls just below 8.5 mg/dl, there
will be mild tremors.
When the serum calcium level is less than 7.5 mg/dl, there will be
manifestation of tetany.
Tetany:
Causes of tetany:
1. Accidental surgical removal of parathyroid gland
2. Autoimmune diseases of parathyroid gland
Clinical signs of tetany:
3. Chovstek’s sign: tapping over the 5th cranial nerve will
induce facial contraction
4. Trousseu’s sign: infation of B.P. cuff above the level of