5-minute Biochemistry

What do we have?

• Most abundant mineral in

the human body
 Forms of Calcium

Mineral Hydroxyapatite Plasma Calcium

 45% 45% 10%
Protein-bound Complexed/Chelated
Ionized Form
Form Form

Bound to
bicarbonate,
The most active Bound to protein
phosphate,
form (mostly albumin)
sulfate, citrate
and lactate
Biochemical Importance

Development of Bones and Teeth

Muscle Contraction

Blood Coagulation
 Biochemical Importance

Nerve Transmission

Membrane integrity and permeability

Enzyme Activation
Calcium also helps in…

Release of hormones

Insulin Parathyroid Hormone Calcitonin

Cellular Structures

Mitochondria

Endoplasmic Reticulum
Calcium Absorption

Renal
Transcellular Paracellular
Reabsorption
• Through cell • Between cells • Proximal
• Duodenum • Jejunum, convoluted
ileum, colon tubules of
nephrons
Factors Affecting Calcium Absorption

PROMOTES INHIBITS

Vitamin D Phytates and Oxalates

PTH Dietary Phosphate

Acidity Alkalinity

Lactose FFA

Amino Acids (Lycine, Arginine) High Dietary Fiber

Calcium Metabolism
Changing Cytosolic Ca2+ levels

Certain hormones by
binding to receptors,
enhance permeability to
Ca2+ increasing Ca2+ influx

Hormones indirectly
promote Ca2+ influx

Ca2+ can be mobilized

from the
endoplasmic
reticulum
Hormones that regulate Calcium metabolism

Parathyroid Hormone 1, 25- Calcitonin

Dihydroxycholecalciferol
Calcium Homeostasis
Recommended Daily Intake

CLASSIFICATION RECOMMENDED CALCIUM INTAKE

Infants (0-6 months old) 400 mg/day

Children (1-10 y/o) 500-1200 mg/day

Adults (11-24 y/o and above); pregnant 1200 - 1500 mg/day

and nursing women
1000 mg/day (1500 mg/day for over 65
25-65 y/o male; 25-50 y/o female men and over 50 female
Source of Calcium
Biochemical Pathophysiology

Hypocalcemia

Hypercalcemia
 Hypocalcemia
Total serum calcium concentration < 8.8 mg/dl (< 2.20 mmol/L) in the presence of
normal plasma protein concentrations or as a serum ionized calcium concentration <
4.7 mg/dl (< 1.17 mmol/L)

Low Ca2+ levels (hypocalcemia) facilitate sodium transport, as the normal inhibition
by Ca2+ of sodium movement through voltage-gated sodium channels is lost.

Low Ca2+ levels result in hyper-excitability of excitable cells, such as neurons.

Trousseau’s sign and Chvostek’s sign

Seizures

Cardiac Arryhthmias
Trousseau’s sign

Occlusion of the brachial artery causes flexion of the wrist and

metacarpophalangeal joints, hyper-extension of the fingers, and
flexion of the thumb on the palm, producing a characteristic
posture.
Chvostek’s sign

The facial muscles on the same side of the face will contract
momentarily, as the tap will stimulate hyperexcitable motor axons
 Hypercalcemia
When too much calcium enters the extracellular fluid or insufficient calcium excretion
from the kidneys.

90% of cases of hypercalcemia > caused by hyperparathyroidism or malignancy

Severity of symptoms > absolute calcium level + fast the rise in serum calcium
occurred
Mild prolonged hypercalcemia may produce mild or no symptoms, or recurring
problems such as kidney stones
Sudden-onset and severe hypercalcemia cause confusion and lethargy, possibly
leading quickly to death
Serum calcium levels greater than approximately 15 mg/dL usually are considered to
be a medical emergency and must be treated aggressively
 Hypercalcemia

Usually results from excessive bone resorption. Most common causes are:
Hyperparathyroidism and Cancer.

Cancer

Familial hypocalciuric hypercalcemia (FHH)

 Hypercalcemia

Mild Total Ca 10.5-11.9 mg/dL (2.5-3

mmol/L) or Ionized Ca 5.6-8 mg/dL
(1.4-2 mmol/L)
Moderate Total Ca 12-13.9 mg/dL (3-3.5 mmol/L)
or Ionized Ca 8-10 mg/dL (2-2.5
mmol/L)

Hypercalcemic Crisis Total Ca 14-16 mg/dL (3.5-4 mmol/L)

or Ionized Ca 10-12 mg/dL (2.5-3
mmol/L)
Remember…
Safety First!
Thank you
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