CALCIUM HOMEOSTASIS

V.YUVARAJ
ROLL NO. : 150
FIRST YEAR MBBS
WHY
Why calcium needs to be maintained within
it’s normal range ?

HO How calcium homeostasis is achieved ?

W
WHA What will happen if calcium homeostasis
is not achieved ?

T
 TOTAL BODY CALCIUM

99 % 0.1%
1%
(1000 g) (1.3 g)
(13 g)

BONES IN THE CELLS EXTRACELLULAR FLUID

 Distribution of serum calcium
Normal serum calcium – 8.8 – 10.6 mg/dl

Ionised calcium Calcium complexed to anions Protein bound calcium

(50%) (9%) (41%)
Free calcium or Complexed to citrate, PO43-, HCO3- Non diffusible calcium
diffusible calcium

Albumin bound Globulin bound

(37%) (4%)

Ionised calcium (Ca2+) is the physiologically active form

 Why calcium needs to be maintained within it’s normal range ?

Development of teeth

Development and Cardiac muscle

maintenance of bone density contraction

Nerve excitability Skeletal muscle contraction

Hemostasis
OUTLINE OF CALCIUM METABOLISM
 How calcium homeostasis is achieved ?

“Three hormone – Three organ”

Three Hormone Three Organ

 Parathyroid Hormone Bone
 Vitamin D Intestine
 Calcitonin Kidney
PARATHYROID HORMONE
 MECHANISM PTH
CaSR

PLC
Ca 2+

Ca2+
Gq

PIP2
Ca 2+

DAG IP3 Ca2+

Ca2+

Ca2+
ER
Ca2+
PKC
 ACTION OF PTH ON BONE
PTH
OSTEOBLAST OSTEOCLAST

RANKL
M-CSF

BONE RESORPTION
Increase serum calcium concentration
 ACTION OF PTH ON KIDNEY
• Inhibits PO4 reabsorption (inhibits Na-PO4
cotransport in PCT)  phosphaturia  less
complexed Ca-PO4  increases serum
calcium
• Stimulates calcium reabsorption (on DCT)

Phosphaturia + Ca2+ reabsorption = Increase in

serum Ca2+ concentration
 ACTION OF PTH ON INTESTINE

• Action is indirect
• Increase calcium absorption by stimulating
vitamin D production

PTH stimulates renal 1 α hydroxylase 

converts 25-hydroxycholecalciferol to 1,25
dihydroxycholecalciferol  stimulates
intestinal Ca2+ absorption
VITAMIN D
 ACTION OF VITAMIN D ON BONE

• VDR in osteoblast increase bone matrix

protein production osteocalcin and osteopontin

• RANKL aids in osteoclast differentiation

increases osteoclast activity by binding
through its receptor RANK on osteoclast
 ACTION OF VITAMIN D ON KIDNEY

• Facilitates Ca2+ reabsorption (in PCT)

• Increasing PO4 by increasing the activity of

Na-PO4 cotransporter
 CALCITONIN
• Weak effect on plasma calcium concentration
• Immediate effect  decrease absorptive
activity of the osteoclast
• Prolonged effect  decrease formation of new
osteoclast
 What will happen if the calcium homeostasis is not
achieved ?

• Decreased serum calcium level below

8.7 mg/dl results in hypocalcemia

• Increased serum calcium level above

10.4 mg /dl results in hypercalcemia
 HYPOCALCEMIA
SYMPTOMS :
“CATS go numb”
Convulsions, Arrythmias, Tetany and
Numbness in hands, feet around mouth and
lips
SIGNS :
* TROUSSEAU SIGN
* CHVOSTEK’S SIGN
 HYPERCALCEMIA
“Stones, bones, Groans and psychiatric
overtones”
• Stones (renal or biliary)
• Bones (bone pain)
• Groans (abdominal pain, nausea, vomitting)
• Psychiatric overtones (depression, cognitive
dysfunction, insomnia)
 CALCIUM IMBALANCE
DYSFUNCTION HYPOCALCEMIA HYPERCALCEMIA
Arrythmia, hypotension
Cardiovascular
Anxiety, irritability,
Central nervous system laryngospam, seizures
Increased GI motility,
GI diarrhoea
Paresthesia, tetany, muscle
Musculoskeletal spasms, abdominal cramps
Blood clotting
Others abnormalities (rare)
Signs of heart block, cardiac
arrest in systole
Drowsiness, lethargy,
depression, confusion,
coma
Anorexia, constipation
Weakness, muscle
flaccidity, bone pain
Polyuria, renal calculi
 REFERENCES
1. Medical physiology by Boron and Boulpaep
2. Berne and levy physiology – 7th edition
3. Ganong’s review of medical physiology