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Mineral Metabolism
and Abnormalities

LE DUONG HOANG HUY M.D

Email: huyldh@pnt.edu.vn
Contents

1 Calcium

2 Phosphorus

3 Magnesium

4 Iron & Copper

5 ZinC
Major elements
Trace elements
Calcium
Discussion
1. Sources of Calcium
2. Daily Requirement
3. Absorption
Mechanism of Absorption of Calcium
Factors Causing Increased Absorption
Factors Causing Decreased Absorption

4. Functions of Calcium
Calcium
5. Factors Regulating Blood
Calcium Level

6. Hypercalcemia & Hypocalcemia

Calcium
1. Sources of Calcium
 Milk (cow’s milk ~100mg/100mL)
 Egg
 Fish
 Vegetables
 Cereals
Calcium
2. Daily Requirement
 Adults: 500mg/day

 Child: 1200mg/day

 Pregnancy:1500mg/day

 After 50 years old: 1500 mg/day plus

vitamin D 20 mg/day (osteoporosis)
Calcium
• 3. Absorption
- Duodenum
- Requires energy and carrier
protein
Calcium
3. Absorption
Factors Causing Increased Absorption
Vitamin D
Parathyroid hormone
Acidity
Amino acids
Calcium
3. Absorption
Factors Causing Decreased Absorption

Phytic acid
Oxalates
Malabsorption syndromes
Phosphate
Calcium
4. Functions of Calcium
4.1 Activation of Enzymes
+ Activation of enzymes through calmodulin

+ Some other enzymes are activated directly

by Ca++ without the intervention of
calmodulin; examples arepancreatic lipase;
enzymes of coagulation pathway; and rennin
Calcium
4. Functions of Calcium
Calcium
4. Functions of Calcium
4.2 Muscles
Calcium mediates excitation and contraction
of muscle fibers
Calcium
4. Functions of Calcium
4.3 Nerve Conduction
Calcium
4. Functions of Calcium
4.4 Secretion of Hormones & Second Messenger

4.5 Vascular Permeability

4.6 Bone and Teeth

4.7 Coagulation

4.8 Bone & teeth formation

Calcium
5. Calcium in Blood
Normal blood level: Normal calcium level is
9–11 mg/dL. (10 mg/dL of Ca++ = 5 mEq/L)
Calcium
6. Factors Regulating Blood
Calcium Level
Vitamin D
Parathyroid Hormone (PTH)
Calcitonin
Phosphorus
Serum Proteins
Alkalosis and Acidosis
Kidney Threshold
 Calcium
6.1 Vitamin D
 Calcium
6.2 Parathyroid Hormone (PTH)

PTH:
 Activates adenyl cyclase

 Causes demineralization or
decalcifcation in bone

 Increases in reabsorption
of calcium from kidney
tubules.

 Increases calcium
absorption from intestine.
 Calcium
6.3 Calcitonin
+ Calcitonin decreases serum calcium level
+ Calcitonin and PTH are directly antagonistic.
+ The PTH and calcitonin together promote the bone
growth and remodeling
 Calcium
6.3 Calcitonin
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 Calcium
6.4 Phosphorus
- There is a reciprocal relationship of
calcium with phosphorus.
- The ionic product of calcium and
phosphorus in serum is kept as a
constant
 Calcium
Besides, some factors can regulate
calcium level such as age, serum
proteins, alkalosis-acidosis, kidney
threshold
 Hypercalcemia
Blood calcium level ≥ 11mg/dL
Major cause is hyperparathyroidism.

Tests ???
Hypercalcemia

1. Estimation of serum calcium,

phosphate and alkaline phosphatase.
2. Urinary calcium and phosphate levels.
3. Calcium load test

4. TRP (tubular reabsorption of

phosphate) test
5. PTH level in serum
Hypocalcemia
Serum calcium level< 8.8 mg/dL

< 8.5 mg/dL: mild tremors.

< 7.5 mg/dL: tetany
Hypocalcemia
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PHOSPHORUS & MAGNESIUM

Discussion
 Functions
 Normal level
 Requirement
 Hypo- & Hyper-
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PHOSPHORUS

80% of phosphorus is seen in bone

10% in muscles

An intracellular ion and is seen in

all cells
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PHOSPHORUS
Functions
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PHOSPHORUS
Requirement is about 500 mg/day

Serum level of phosphate is:

 3–4 mg/dL in normal adults
 5–6 mg/dL in children
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PHOSPHORUS
Phosphate level in blood is
controlled by the parathyroid
hormone
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PHOSPHORUS
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MAGNESIUM

Mainly seen in intracellular fluid.

Requirement:
 ~ 400 mg/day for men
 ~ 300 mg/day for women
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MAGNESIUM

Normal serum level Mg is 1.8--

2.2 mg/dL
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MAGNESIUM
Functions of Magnesium
1.Mg is the activator of many enzymes requiring ATP.
Alkaline phosphatase, hexokinase, fructokinase,
phosphofructokinase, adenyl cyclase, cAMP dependent
kinases, etc. need magnesium.

2. Neuromuscular irritability is lowered by magnesium.

3. Insulin-dependent uptake of glucose is reduced in

magnesium defciency. Magnesium supplementation
improves glucose tolerance
IRON

 Total body iron content is 3 to 5

g
 About 75% of total iron is in
hemoglobin, and 5% is in
myoglobin and 15%in ferritin
IRON
Iron is a critical element in the
function of all cells.

The major role of iron in mammals is

to carry O2 as part of hemoglobin. O2 is
also bound by myoglobin in muscle

Iron is a critical element in iron-

containing enzymes, including the
cytochrome system in mitochondria
IRON
IRON METABOLISM

Terms

 Ferrous iron:iron with an oxidation

state of +2 (Fe2+ or Fe[II])

 Ferric iron:iron with an oxidation

state of +3 (Fe3+or Fe[III])

 Ferroxidase: any of a class of enzyme

that oxidizes ferrous (Fe2+) iron to
ferric (Fe3+) iron

 Ferrireductase:any of a class of
IRON METABOLISM
IRON METABOLISM
IRON METABOLISM
IRON METABOLISM

• Iron need:

• 1 mg/d is required from the diet in

men
• 1.4 mg/d in women to maintain
homeostasis.
IRON METABOLISM

• Iron balance

• The balance of iron in humans is

tightly controlled and designed to
conserve iron for reutilization.

• There is no regulated excretory

pathway for iron, and the only
mechanisms by which iron is lost are
blood loss and the loss of epithelial
cells.
IRON METABOLISM
Hepcidin, the principal iron regulatory
hormone
IRON-DEFICIENCY ANEMIA

• 50% of anemia is attributable to iron

deficiency

• accounts for approximately 841,000

deaths annually worldwide.
IRON-DEFICIENCY ANEMIA
• Causes Of Iron Deficiency
IRON-DEFICIENCY ANEMIA
• Stages Of Iron Deficiency

• Three stages:
 negative iron balance

 iron-deficient erythropoiesis

 Iron-deficiency anemia
IRON-DEFICIENCY ANEMIA
IRON-DEFICIENCY ANEMIA
IRON-DEFICIENCY ANEMIA
Copper

 Total body copper is about 100 mg.

 It is seen in muscles,liver, bone

marrow, brain, kidney, heart and in
hair
Copper

 Copper requirement for an adult

is 1.5 – 3 mg perday.

 Major dietary sources are cereals,

meat, liver, nuts and green leafy
vegetables.
Copper

 10% of dietary copper is absorbed.

 Excretion is mainly through bile

 Urine does not contain copper in

normal circumstances.
Copper

 In plasma ceruloplasmin is an
important coppercontaining protein

 Normal serum level of

ceruloplasmin is 25–50 mg/dL
 Functions of Copper
1. It is necessary for iron absorption and
incorpo ration of iron into hemoglobin.
2. It is necessary for tyrosinase activity.
3. It is a co-factor for vitamin C requiring
hydroxylations.
4. It increases HDL and so protects the heart
Copper

 Wilson’s disease
Zinc

 Total zinc content of body is about 2 g

 60% is in skeletal muscles and 30% in
bones

 Rich dietary sources are grains, beans,

nuts, cheese, meat and shellfish.
Zinc

 In liver, zinc is stored in combination with

a specifc protein, metallothionein

 Zinc is mainly excreted through

pancreatic juice

 More than 300 enzymes are zinc

dependent
 A 54-year-old grossly overweight woman presented with
complaints of cramps and spasms of both hands. She was
depressed and had positive Trosseau’s and Chovstek’s
signs.Past medical history revealed history of thyroidectomy
for Grave’s disease. The laboratory results obtained were as
follows:
Serum Creatinine – 1.0 mg%, Serum Calcium – 4.1
mg%, Serum phosphate – 5.9 mg%, ALP – 60 IU/L,
Serum Albumin – 4.0 g%.
Comment on the laboratory results and give your likely
diagnosis. What additional tests are to be done to come to
aconclusive diagnosis?
Thank you !!!