PHYSIOLOGY: Hormone Regulation of Mineral Metabolism 3
How PTH works:
When you have very high levels of PTH,
. A high activity of boneresorption means there will be a release of calcium and phosphate from the skeletal system.These go to the ECF.Therefore, calcium serum level rises, and,theoretically, phosphate levels should rise too.However, it was found that when you have highPTH, there is indeed a rise in calcium levels BUT
phosphate levels seem to decrease
. This is due tothe effect of the PTH on the kidneys.
Effect of PTH on Kidneys1. Promotes calcium reabsorption
Therefore, calcium serum levels ELEVATE more.
occurs in the
2. Promotes phosphate excretion
So you lose a lot of phosphate through theurine.This action of the PTH on the kidneys isgreater/more dominant than the effect of PTH onthe bone. Therefore, even if phosphate is releasedin the bones too, the net effect is that it causesyour phosphate levels to
in the serum.Reducing phosphate levels is actually veryimportant because if both calcium and phosphateare very high in your serum, there is a tendencyfor mineralization of bone rather than increasingserum calcium levels.
What regulates the PTH secretion?
Amount of ionized calcium in the body.This is a
negative feedback effect
, wherein if calcium in the serum is high, amount of PTH islow. But, if serum calcium is low, PTH secretion ishigh.Again:Low ionized serum calcium = High PTH secretionHigh ionized serum calcium = Low PTH secretionThere are also other factors that can change theamounts of total serum calcium such as
change inacid‐base balance
If in a state of acidosis, the
acidosis will displace
calcium from its binding with protein.On the other hand,
alkalosis can enhance
thebinding of ionized calcium to protein, thereby
the ionized portion!
A case wherein an individual hyperventilates, thusCO
is blown off. This induces
.The alkalosis will cause the calcium to bind more,and therefore the ionized serum calcium level goesdown. As a result, these people present with a formof
(Since calcium is involved in muscular excitability)
How is the amount of ionized serum calciumdetermined if we can only measure total serumcalcium?
They found out that about 50% of the total serumcalcium is ionized.
The other 50% is not ionized because 40% is bound toprotein, whereas the other 10% is complexed withdiffusable anions.So, when there is a change in serum protein levels(especially albumin, since calcium is really bound toalbumin), there is bound to be a change in the totalserum calcium concentration as well.They postulated that if there is a decrease in serumalbumin levels by about 1mg/deciliter, then the totalserum calcium concentration will also be reduced byabout 0.8 mg/dL.