Minerals 368
Calcium homeostasis (Blood calcium level and factors regulating it):
Normal blood calcium level is 9 to 11 mg / dl.
Blood calcium level is maintained within the normal level by various factors. They are,
1) Vitamin D
2) PTH
3) Calcitonin
1. Vitamin D:
It has hypercalcemic effect. It increases the blood calcium level. It has three major
independent sites of action - intestine, kidney and bones.
i) Intestine: Ca lcitriol induces the syn thesis of a carrier protein (Calcium binding protein,
CBP) in the intestinal mucosa, which increases absorption of calcium and blood
calcium level.
ii) Kidney: PTH activity on kidney is enhanced by vitamin D, which increases
reabsorption of calcium.
iii) Bones: Vitamin D enhances osteoblastic activity of bones and thus promotes
calcification of bones mainly in growing children, but it causes bone resorption
during hypocalcemia in order to maintain the blood calcium level.
2. Parathyroid hormone (PTH):
PTH is a hypercalcemic hormone. It has three major independent sites of action -
intestine, kidney and bones.
i) Intestine: PTH stimulates production of calcitriol which increases intestinal absorption
of calcium.
ii) Kidney: PTH increases calcium reabsorption by kidney tubules.
iii) Bones: PTH causes demineralization (resorption) of bones, resulting in increasing
blood calcium level. But this activity is mainly seen during calcium deficiency.
3. Calcitonin:
Calcitonin is secreted by parafollicular cells of thyroid gland. Calcitonin is a hypocalcemic
hormone, which decreases the blood ca lcium level.
i) Kidney: Calcitonin inhibits calcium reabsorption by lodneys
ii) Bones: Calcitonin inhibits bone resorption by increasing activity of osteoblasts and
decreasing activity of osteoclasts.
Phosphate (PO/) level also has an effect on calcium homeostasis:
Hypophosphatemia (Decreased serum PO/ level) increases the serum calcium level.
Hypophosphatemia enhances the hydroxylation (activation) of vitamin D in kidnet;s to form
calcitriol, which has hypercalcemic effect.
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Minerals 369
Clinical aspects:
Normal blood/ plasma calcium level is 9 to 11 mg/ dl.
H ypocalcaemia:
Definition:
When the plasma calcium level is below 9 mg/ dl, condition is known as hypocalcaemia.
Causes:
• Vitamin D deficiency
• Hypoparathyrodism
• Accidental surgical removal of parathyroid glands (generally during thyroidectomy
due to its close proximity to thyroid gland),
• Dieta ry deficiency of calcium,
• Steatorrhea (due to accumulation of fatty acids, which inhibit calcium absorption),
• Chronic renal diseases (due to impaired formation of calcitriol which is required for
calcium absorption).
Manifestations:
Calcium decreases neuromuscular excitability. Deficiency of calcium increases
neuromuscular excitability. When serum calcium level is less than 8.5 mg %, mild
tremors (hyper-excitable state of the nerve and muscle) are seen. If it is lower than 7
mg % a life threatening condition called tetany will occur. Symptoms include numbness
of extremities, emotional irritability, tightness and spasm of m uscle, muscle cramps,
convulsions etc.
Two clinical signs, Chvostek's sign and Trousseau's sign will be positive.
Low levels of calcium also lead to bone deformities.
Hypercalcemia:
Definition:
When blood calcium level increases above 11 mg/ dl, the condition is known as
hypercalcemia.
Causes:
Hypervitaminosis D and Hyperparathyroidism.
Symptoms:
An increased excretion of urinary calcium leading to renal calculi. Bone deformities
(due to increased bone resorption), ectopic calcification of urinary bladder, renal tissues,
pancreas etc, anorexia, depression and muscle weakness are other symptoms.
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