DISTURBANCES IN MINERAL METABOLISM

 Minerals are inorganic elements that are

essential for life and provide both the structural
and regulatory function of the body.
 There are at least 29 different elements in our
body making about 4% of body weight and
present mostly in skeleton.
 The elements essential are Ca, P, Mg, K, Na,
Cal, I, Cu, Fe, Zn, Mn, Co, Cr, Se and F.
 Minerals, which are present in high amount, are
called as macro minerals and those that are less
than 0.005% of the body weight are called as
the micro minerals.
 Macro minerals- Na, K, Cl, Ca, P, Mg and S.
 Requirement of micro minerals is less than
100mg /day.
 The other trace elements are cadmium, nickel,
silicon, tin and vanadium.
  Inorganic and organic combinations of these
elements are active in many physiological
processes.

1.They constitute basic structure of bone and

teeth.
2.Helps maintaining the osmotic relation of
body fluids.
3.Regulate the acid-base equilibrium of the
tissues.
4.Form part of hormones.
5.Integral part of some enzymes.
6.Serve as activator of certain enzymatic
reaction.
7.Essential part of oxygen-carrying pigments.

CALCIUM: -
 5th most abundant element in the body & in
crystalline form, with phosphorus, in a
proteinaceous matrix, forms the major
structural support of the body [bones].
 Total calcium-100-170 gm [99% in bones]
 Normal serum Ca level-9-11mg/dl.
  Ca in plasma is of three type-ionized, protein
bound & complex calcium.

REQUIREMENT & ABSORPTION-

 The food & nutrition board of the national
academy of sciences, national research council,
recommends a daily Ca intake of 360 mg, for
newborn infants & 800 mg for children &
adults.
 Adolescents, pregnant, & lactating women-
1200 mg.
 1/3rd of daily intake is absorbed from
duodenum & jejunum.
 Phytic acid, found in cereals, forms an
insoluble Calcium phytate with ingested Ca &
renders it non available.
 Vitamin D increases absorption of Ca from the
intestine.
 Citrates lower PH of GIT; form Ca citrate,
which is relatively soluble.
 Oxalic acid interferes with Ca absorption by
forming an insoluble Ca oxalate.
 Lactose or milk sugar increases absorption.
EXCRETION: -
 Ca is excreted in both feces & urine, with 80%
being excreted in feces.
 The normal daily urinary output in adult is less
than 250 mg for women & 300 mg for men.
FUNCTION: -
 Formation of bone & teeth.
 Maintenance of skeletal structure.
 Normal membrane permeability.
 Normal heart rhythm, & other neuromuscular
excitability.
 In the coagulation of blood.
 Muscle contraction.
 As a secondary or tertiary messenger in
hormone action.
 Low concentration of Ca produce
hyperirritability & tetany.
 HYPOCALCEMIA-8.5 mg/dl, cause
hypoalbuminemia & surgically induced
hypoparathyroidism.
 Hypercalcemia->11.0 mg/dl.
OSTEOPOROSIS & Ca DEFICIENCY-

 It results due to long term negative Ca

balance.
 Skeletal mass in old age is proportional to
skeletal mass at maturity, indicating that infant
& childhood Ca intake may play a major role in
the occurrence and severity of disease in later
years.
 Androgen & estrogen therapies have been
replaced by increased Ca intake & strontium &
sodium fluoride ingestion.
 In majority of osteoporotic patients, Ca
balance can be achieved with a high Ca intake.

PHOSPHORUS: -
 Total body P-500-800 gm [85-90% in
skeleton].
 Major portion of phosphorus is incorporated
into organic phosphorus compound.
 Inorganic phosphate level of blood –2-4
mg/dl in adults & 3-5 mg/dl in children’s.
REQUIREMENT & ABSORPTION-
 Daily dietary intake-240 mg in infants & 800
mg in adults.
 In pregnant & lactating women-1200 mg.
 90% is absorbed.
 Excess of Ca, Fe or Al interfere with
absorption of P
.
EXCRETION-
 Regulation of Ca & P is under the similar
control mechanisms by kidney w.r.t.
parathormone & vitamin D.

FUNCTIONS-
 Phosphates in metabolism of bone & teeth.
 Intermediate states in metabolism of fat &
carbohydrates by their function in
phosphorylation.
 Utilized in formation of phosphoproteins.
 They provide the energy rich bonds such as
ATP.
 Part of coenzymes as pyridoxal phosphate.
  Long term antacid use, make phosphate
unabsorbable, symptoms-weakness, malaise,
anorexia, & bone pain.
 Rickets & osteomalacia are important
dietary deficiency disorders of Ca, P or vitamin
D.
 Hypophosphatemia -due to-decreased intake,
malabsorption, increased cell uptake, liver
disease, increased excretion, hypomagnesemia
& increased parathormone

MAGNESIUM-
 4th most abundant & important cation in
human.
 Present as intracellular ion in all living cells
& tissues.
 Mg participates in every phosphorylating
mechanism.

BODY DISTRIBUTION-
 Body of a 70 kg man contains approx. 0.25
mg of Mg.
  Half of this in bones & one quarter in
muscles.
 The left is distributed in liver, pancreas,
erythrocytes, serum & CSF.

REQUIREMENT-
 Daily dietary intake –50 mg in infants, 400
mg in teenager males, 550 mg in pregnancy &
lactating mother.

ABSORPTION-
 In small intestine
 Since there is a common transport
mechanism from intestinal tract for both Ca &
Mg, decreased absorption in the presence of
excess Ca.
 Vitamin D, parathormone, growth hormone,
and high protein intake & neomycin therapy
increases absorption.

EXCRETION-
 60% in feces, rest is urinary.
 HYPERMAGNESEMIA-rare
  The administration of Mg contains antacids to
patients with renal insufficiency has resulted in
CNS depression.
 A high Mg intake will produce rickets in
growing children’s.
 Normal serum Mg level-1-3 mg/dl.
 When level reaches 5 mg/dl –sedative or
hypnotic effects occur.
 Coma & death may result when the serum
level reaches 18-21 mg/dl.

FUNCTION-
 Mg is involved as a cofactor and as an activator
to a wide spectrum of enzymatic actions.
 It is essential for peptidases, ribonucleases,
glycolytic enzymes & cocarboxylation
reactions.
 Mg also exerts an effect in neuromuscular
irritability.
 High levels depress nerve conduction and low
level may produce tetany.
DEFICIENCY-
 VALLEE & his associates first described the
syndrome of human Mg- deficiency tetany in
1960.
 Patients exhibit a semi coma & severe
neuromuscular hyperirritability, including
carpopedal spasm, marked susceptibility to
auditory, visual & mechanical stimuli; a
decreased serum Mg; & a normal serum Ca
concentration.
 Precipitating factors are –dietary inadequacy,
excessive loss of ion due to vomiting, intestinal
malabsorption & the administration of large
amounts of Mg free parenteral fluids, which
induce a large urine volume.

TREATMENT-
 Intramuscular injection of magnesium sulphate.

PATHOLOGICAL CALCIFICATION-
 It is the abnormal deposition of Ca salts
together with smaller amounts of Fe, Mg &
other mineral salts.
  It is of three types: - dystrophic, metastatic &
calcinosis.

DYSTROPHIC CALCIFICATION-
 Calcium salts are deposited in dead or
degenerating tissues.
 Most frequently occurred.
 SITES-area of tuberculous necrosis, blood
vessels in arteriosclerosis, scars & area of fatty
degeneration.
 A local basicity in comparison with adjacent
undamaged tissue appears to be an important
factor in initiating the precipitation of Ca in
degenerating or non-vital tissues.
 In mouth- gingival, tongue or cheek, in benign
fibroma of mouth.
 Most commonly- pulp of teeth.
 They occur in the wall of blood vessels or in
the perineural C.T. of pulp or they may be
rather diffusely scattered both in the pulp
chamber in the root canal.
 Calcific degeneration-2 types.
 1.Nodular type in hyaline C.T.
2.Calcification that found in & around Necrotic
cells & corpora amylacea.

METASTATIC CALCIFICATION: -
 Calcium’s salts are precipitated in previously
undamaged tissues.
 This is due to excess of blood calcium & occurs
particularly in such diseases as
hyperparathyroidism, which depletes the bone
calcium & causes a high level of blood
calcium.
 It also occurs in hypervitaminosis D.
 Deposits occur in kidneys, lungs, gastric
mucosa & media of blood vessels.

CALCINOSIS: -
 Is the presence of calcifications in or under the
skin.
 2 forms: - Calcinosis circumscripta &
Calcinosis universalis.
SODIUM: -
 The sodium in body is mainly associated with
chloride & as sodium chloride & sodium
bicarbonate.
 Sodium ion content- 83-97gm.
 1/3rd in skeleton.
 Enamel ash contains about 0.3%
REGULATION & EXCRETION: -
 Daily intake- 0.5gm. (Minimum.)
 Cow milk- 1.7gm. NaCl per ltr.
 Normal blood level- 160 mg/dl.
 Plasma- 340 mg/dl.
 Kidney is principal organ for excretion.
 Controlled by adrenal glands.
FUNCTIONS: -
 Important in maintenance of acid-base
equilibrium as well as of osmotic pressure.
 When tissues are depleted of potassium,
sodium may substitute for it, regulating the
contraction of heart.
  Sodium also helps in maintaining the
neuromuscular excitability, viscosity of blood
& fluid balance.
 Deoxycorticosterone, cortisone &
hydrocortisone act to increase the tubular re-
absorption of glomerular filtrate of sodium.
 2 types of clinical condition- hypernatremia &
hyponatremia.
DEFICIENCY: -
 Where diets very low in salt are used for long
periods of time, gradual weakness, excessive
fatigue, lassitude, apathy, anorexia, nausea,
muscle cramps & peripheral vascular collapse
may ensue.

POTASSIUM: -
 It is the major intracellular cation.
 Distributed in body fluid & tissue such as
nerves, muscles as well as in cells.
 Most of K is intracellular.
REGULATION & EXCRETION: -
 4gm of K is present in diet.
 Requirement is maximum at time of growth.
  90% is excreted in urine, which is influenced
by aldosterone.
 Normal human- 3.6 moles of K.
FUNCTIONS: -
 It influences the muscular activity.
 Involved in acid-base balance.
 Role in cardiac function.
 In neuromuscular irritability.
 Nerve conduction.
DEFICIENCY: -
 Mainly occur in GIT disorders- diarrhea &
vomiting.
 In malnutrition also.
 Death in K deficiency may result from cardiac
or respiratory failure or from paralytic ileus.

SIGNS OF POTASSIUM DEFICIENCY-

 Decreased muscular irritability, muscular
weakness, reduced reflexes, mental confusion,
paralysis, and disturbance in conductivity &
contractility of heart muscles &alterations in
GIT.
HYPERKALEMIA-
 Result due to excessive tissue breakdown,
adrenal insufficiency, advanced dehydration or
administration of excessive amounts of K will
produce such signs & symptoms as mental
confusion, numbness & tingling of the
extremities, pallor, cold skin, weakness,
disturbances in cardiac rhythm & peripheral
collapse.

CHLORINE-
 Average intake-6-9gm/dayin form of NaCl.
 Absorption occurs from small intestine.
 Excretion occurs via kidney.
 Normal blood plasma concentration-550-
650mg/dl as NaCl.
 Chlorine produces HCl in gastric juice & also
important in chloride shift.
 It activates salivary amylase.
 Large quantity of chlorine may be lost in
pyloric obstruction with gastric tetany leading
to sign of hyper excitability & convulsions.
TRACE ELEMENTS-
IODINE-
 Seafoods are the best natural source.
 Normal blood contains an average of 8-12
micro gm/dl; protein bound iodine varies from
3-8 micro gm/dl.
 The level of protein bound iodine is increased
during pregnancy & in hyperthyroidism &
decreased in hypothyroidism.
 Iodine is essential for formation of thyroid
hormone.
 Iodine deficiency results in goiter.
 1/3rd of total body iodine is found in thyroid.

IRON-
 Most essential element.

REGULATION & ABSORPTION-

 An adult male require 10 mg/day & female
requires 20mg/day.
 Children need 10-15mg/day.
 Iron is absorbed in the upper portion of the
duodenum, either as ferrous or ferric salts.
 Anemia occurs due to iron deficiency.
 Changes in resulting anemia include formation
of an esophageal web in the plummer-vinson
syndrome, spooning of nails, normoblastic
arrest in the bone marrow & microcytosis &
anisocytosis.
 Idiopathic haemochromatosis results in
excessive iron absorption & is characterized by
micro nodular cirrhosis with marked brown
pigmentation called as “bronze diabetes”.
 Bantu siderosis- a form of iron overload
regulating from ingestion of home made beer
fermented in iron pots.

FLUORINE-
 One part of fluorine in one million part of
drinking water seems to serve the daily
requirement of fluorine in human adults &
children’s.
  Daily dietary fluoride should not exceed 3mg.
 Fluorides are mainly excreted in urine.
 Fluorine is present in the human tooth in trace
quantity & help in tooth development &
hardening of surface enamel.
 Fluorine is cariostatic.
 Excess is harmful & cause fluorosis.
 Increased fluoride levels adversely affect the
collagen synthesis.
 Excess of fluoride in drinking water or diet is
harmful and is considered to be the main cause
of the crippling disease known as fluorosis.
 Chronic fluoride intoxication is characterized
by widespread calcification of tendons and
muscle sheaths, by extensive arthritic changes
in the spin, producing rigidity, and by
osteosclerosis of the bones.

ZINC: -
 Zinc is obtained from liver, milk and
dairy products, eggs, unmilled cereals,
 legumes, pulses, oilseed, and leafy
vegetables.
 Average man has about 1.4 – 2.3 gm of
zinc.
 Zinc is distributed in highest
concentration in skin and prostate where
it is about 70 to 80 mg / 100 gm
followed by bone and teeth where zinc
concentration varies between 10 to 15
mg/ 100gm.
 The concentration of zinc in enamel and
dentin is about 0.02%, which is higher
than in many other hard tissues of the
body.
 Dietary zinc is absorbed from duodenum
and ileum.
 9.0mg of zinc is excreted through faeces
and urine and only about 0.5mg retained
in the body.
 Daily dose for man and women is 15 to
20 mg zinc (0.3 mg/kg body weight).

FUNCTIONS: -
1.Role in enzyme action as it forms an
integral part of several enzymes.
 2.Important zinc containing enzymes
are superoxide dismutase, carbonic
anhydrase, and leucine
aminopeptidase.
3.Stimulate the release of vitamin A
from the liver into the blood and
thus increaser its plasma level.
4.In diabetes mellitus zinc content of
pancreas is decreased.
5.Necessary for healing of wounds.

The zinc deficient subjects appeared

much younger than their stated age, lacked
facial, axillary and pubic hair, had atrophic
testes and small external genitalia and were
retarded in bone age.
Acrodermatitis enteropathica, a
specific multi-organ disorder resulting from
zinc deficiency, is an autosomal recessive
disorder includes, diarrhea and a wide range
of mucocutaneous problems including
vesicles, eczematoid and hyperkeratotic
plaques, alopecia, stomatitis, and glossitis.