MINERAL METABOLISM

Minerals metabolism
▣ The mineral (inorganic) elements constitute only a
small proportion of the body weight There is a wide
variation in their body content For instance, calcium
constitutes about 2% of body weight while cobalt
about 0.00004%
General functions
▣ Minerals perform several vital functions which are
absolutely essential for the very existence of the
organism.
▣ These include calcification of bone, blood
coagulation, neuromuscular irritability, acid-base
equilibrium, fluid balance, and osmotic regulation.
▣ Several minerals participate as cofactors for
enzymes in metabolism (e.g. Mg, Mn, Cu, Zn, K).
Some elements are essential constituents of certain
enzymes (e.g. Co, Mo, Se.)
Classification

▣ The minerals are classified as.

❑ principal elements
❑ trace elements.
▣ The seven principal elements (macrominerals)constitute
60-80% of the body’s inorganic material.
▣ These are calcium ,phosphorus, magnesium, sodium,
potassium ,chloride and sulfur..
▣ The principal elements are required in amounts greater
than 100 mg/day
▣ The (microminerals) are required in amounts less than
100 mg/day.
❑ They are subdivided into three categories
❑ -Essential trace elements : Iron, copper,iodine,
manganese, zinc, molybdenum, cobalt, fluorine,
selenium and chromium.
❑ -Possibly essential trace elements :
Nickel,vanadium, cadmium and barium.
❑ -Non-essential trace elements : Aluminium,lead,
mercury, boron, silver, bismuth etc
CALCIUM

❑ Calcium is the most abundant among the minerals in

the body. The total content of calcium in an adult
man is about 1 to 1.5 kg.
❑ As much as 99% of it is present in the bones and
teeth.
❑ A small fraction (1%) of the calcium, foundoutside
the skeletal tissue, performs a wide variety of
functions.
Biochemical functions
▣ 1. Development of bones and teeth
▣ 2. Muscle contraction
▣ 3. Blood coagulation
▣ 4. Nerve transmission
▣ 5. Membrane integrity and permeability
▣ 6. Activation of enzymes
▣ 7. Calcium as intracellular messenger
▣ 8. Release of hormones
Control of calcium metabolism
❑ Calcium is present in plasma in three forms.Plasma
Ca2+ is the physiologically important component,
and is closely regulated in humans by
❑ PTH and
❑ 1,25 dihydroxycholecalcifero (DHCC)
❑ The bodys responses to a fall in plasma Ca2+, in
terms of changes in PTH and 1,25‐DHCC
production
 Parathyroid hormone (PTH)

❑ PTH is the principal acute regulator of plasma

Ca2+.
❑ The active hormone is secreted in response to a fall
in plasmaCa2+, and its actions are directed to
increase plasma Ca2+.
❑ An increase in plasma Ca2+ suppresses PTH
secretion.
❑ • In bone, PTH stimulates bone resorption by
osteoclasts, with a requirement for osteoblasts to
mediate this effect
❑ In the kidney, PTH increases the distal tubular
reabsorption of calcium.
❑ It also reduces proximal tubular phosphate
reabsorption and promotes activity of the
1α‐hydroxylation of calcidiol Renal loss of HCO3
also increases which may lead to a mild metabolic
acidosis.
❑ Formation of 1,25‐DHCC indirectly increases the
absorption of calcium from the small intestine
 Vitamin D
❑ The principal action of 1,25‐DHCC is to induce
synthesis of a Ca2+‐binding protein in the intestinal
epithelial cell necessary for the absorption of
calcium from the small intestine.
❑ Deficiency of 1,25‐DHCC leads to defective bone
mineralisation.
❑ Maintenance of both ECF Ca2+ and ECF phosphate
by 1,25‐DHCCmay be a key factor in normal
mineralisation.
.the causes of hypercalcaemia
❑ • Parathyroid disease Hyperparathyroidism, primary
and tertiary; multiple endocrine neoplasia
syndromes.
❑ • Malignant disease Lytic lesions in bone: myeloma,
breast carcinoma
❑ PTHrP: carcinoma of lung, oesophagus, head and
neck, renal cell, ovary
❑ and bladder Ectopic production of 1,25‐DHCC by
lymphomas Uncommon
❑ Endogenous production of 1,25‐DHCC Sarcoidosis
and other granulomatous diseases
❑ Excessive absorption of calcium Vitamin D
overdose (including self‐medication); milk–alkali
syndrome
❑ Bone disease Immobilisation. Drug induced
Thiazide diuretics, lithium
.The causes of hypocalcaemia
❑ Artefact EDTA contamination of sample
❑ Hypoproteinaemia Low serum albumin
❑ Renal disease Hydroxylation of 25‐HCC impaired
Inadequate intake of calcium Deficiency of calcium or
vitamin D, or of both; intestinal malabsorption
❑ Magnesium depletion
❑ Hypoparathyroidism Autoimmune, post‐surgical,
magnesium deficiency, infiltrative disease
Pseudohypoparathyroidism Target organ resistance to
PTH.Neonatal hypocalcaemia
Phosphate metabolism
❑ Eighty‐five per cent of body phosphorus is located in the
mineral phase of bone.
❑ The remainder is present outside bone, largely in an
intracellular location as phosphate compounds.
❑ In the ECF, phosphate is mostly inorganic, where it exists as
a mixture of HPO4, and H2PO4 at physiological pH.
❑ Intracellular phosphate has vital functions in macromolecular
structure(e.g. in DNA), energy metabolism (e.g. energy‐rich
phosphates such as ATP), cell signalling and enzyme
activation by phosphorylation.
❑ Intracellular phosphate is largely organic as a component of
phospholipids,phosphoproteins, nucleic acids and
nucleotides(e.g. ATP).
Hypo‐ and hyperphosphataemia

❑ Phosphate and calcium homeostasis are inextricably

linked
❑ A serum phosphate below 0.4 mmol/L may be
associated with widespread cell dysfunction and
even death.
❑ Muscle pain and weakness, including respiratory
muscle weakness, associated with a raised CK
❑ . Dietary deficiency is unusual (phosphateoccurs widely
in food), but antacids may bind phosphate.
❑ Movement of phosphate into the cell occurs with
metabolic and respiratoryacidosis.
❑ Hypophosphataemia in DKA may be worsened when
insulin is administered (insulin promotes cellular
uptake of glucose and phosphate).
❑ Hyperalimentation or re‐feeding starved patients is also
accompanied by cellular utilisation of phosphate and the
potential for serious hypophosphataemia in the absence
of appropriate supplementation.
Magnesium metabolism
❑ Magnesium is the second most abundant intracellular
cation.
❑ It is essential for the activity of many enzymes including
the phosphotransferases.
❑ Bone contains about 50% of thebody’magnesium; a
small proportion of the body’s content is in the ECF.
❑ Dietary intake of magnesium is normally about 12 mmol
(300 mg) daily. Green vegetables and meat are good
sources.
❑ Significant amounts are contained in gastric and biliary
secretions.
❑ Factors concerned with the control of magnesium
absorption have not been defined, but may involve
active transport across the intestinal mucosa by a
process involving vitamin D.
❑ Renal conservation of magnesium is at least partly
controlled by PTH and aldosterone.
❑ When the dietary intake is restricted, renal conservation
mechanisms are normally so efficient that depletion, if it
develops at all, only comes on very slowly Plasma
magnesium is normally kept within narrownarrow
limits.
❑ which implies close homeostatic control.Marked
alterations in the bodys content can occur with little or
no change detectable in serum magnesium.
❑ In this respect, magnesium is very much likepotassium.
The serum magnesium may be normal although a state
of intracellular depletion exists.