Calcium haemostasis

By:
Vasavi.N
 Plays important role in the body.
 Normal calcium values-1100-

1200mg/day
 Normal plasma calcium value 9-

11mg/dl
 Main functions are:
 Necessary for muscular contraction-

excitation contraction coupelling.

 Helps in the synaptic activity-acts as

neurotransmitter
 Helps in blood clotting
 Acts as second messenger
 Helps in the stabilization of membrane
 Plasma calcium occurs in 2 forms :
 Diffusible
 Non diffusible
 Calcium is present in 3 forms :

Free form
Bound form
Complexed form
 Most of calcium is present in :

Bones
Soft tissues
Ecf
Bone formation
 Active osteoblasts synthesize and extrude
collagen
 Collagen fibrils form arrays of an organic
matrix called the osetoid.
 Calcium phosphate is deposited in the
osteoid and becomes mineralized
 Mineralization is combination of CaP0 , OH-,
4
and H3CO3– hydroxyapatite.
 Mechanism of bone cell formation is by
3 cells :
 Osteoblasts
 Osteocytes
 Osteoclasts
 General diseases in bones are :
 Osteoporosis
 Osteomalacia
 Osteosclerosis
 Osteopetrosis
Hormonal Regulators
Calcitonin (CT)
◦ Lowers Ca++ in the blood
◦ Inhibits osteoclasts
Parathormone (PTH)
◦ Increases Ca++ in the blood
◦ Stimulates osteoclasts
1,25 Vitamin D3
 Calcium homeostasis
storage kidney
bone

calcium deposition Blood

Ca++
calcium resorption
1000 g Ca+
+ stored in
bone

intake Ca++ absorbed Ca++

into blood excretion lost in urine

Calcium in
the diet
calcium lost in feces
small intestine
 OSTEOCLASTS cause resorption of bones

 PARATHYROID HARMONE(paratharmone-PTH)

 There are 2 pairs of parathyroid glands which

are situated in superior and inferior poles of
thyroid gland
 It contains 2 types of cells
 Chief cells-secrete paratharmone
 Oxyphil cells-not known
 Essential for life
 And HPERCALCAEMIC harmone
Parathyroid Glands
 ON BONES-increases plasma calcium and decreases plasma
phosphate levelsby promoting the OSTEOCLASTIC effect
 ON KIDNEYS-increases the reabsorption of calcium from DCT
 Decrease the reabsorption of phoshate-
HYPERPHOSPHOTURIA
 No action the INTESTINE

 Disorders :

 Decrease the plasma calcium causes HYPOCALCAEMIC

TETANY
 Causes for tetany :
 Hypoparathyroidism
 Hypovitaminosis
 Hyperventilation
PTH,
Calcium &
Phosphate
 ON BONES-increases plasma calcium and decreases plasma
phosphate levelsby promoting the OSTEOCLASTIC effect
 ON KIDNEYS-increases the reabsorption of calcium from DCT
 Decrease the reabsorption of phoshate-
HYPERPHOSPHOTURIA
 No action the INTESTINE

 Disorders :

 Decrease the plasma calcium causes HYPOCALCAEMIC

TETANY
 Causes for tetany :
 Hypoparathyroidism
 Hypovitaminosis
 Hyperventilation
 Signs and symptoms
 CARPOPEDAL SPASM
 ACCOUCHERS HAND
 TROUSSEAUS SIGN
 LARYNGEAL STRIDOR
 CHOVSTEKS SIGN
 ERBS SIGN
 INTESTINAL URETERIC SPASM
 SENSORY SYMPTOMS
 ECG CHANGES
 Treatment : calcium glutonate
 HYPER PARATYROIDISM
 VITAMIN-D(CALCITRIOL)
 In the body it is converted to a important

harmone,1,25-dihydroxycholecalciferol
 It is a physiologically active harmone
 It is a HYPERCALCAEMIC harmone
 ACTIONS
 ON BONES-increases osteoclastic activity and

more deposition takes place

 ON KIDNEYS-increases the calcium and

phosphate reabsorption
 ON INTESTINE-increases the calcium and

phosphate absorption
 Regulation of Vitamin D by PTH
and Phosphate Levels
PTH

1-hydroxylase

25-hydroxycholecalciferol 1,25-
dihydroxycholecalciferol

increase
Low phosphate phosphate
resorption
 Disorders :
 RICKETS
 OSTEOMALACIA

 CALCITONIN
 Secreted from parafollicular cells of thyroid
gland also known as THYROCALCITONIN
 ACTIONS
 ON BONES-it exerts its calcium lowering effect
by inhibiting osteoclastic activity i.e, decreases
osteoclastic activity
 Associated with increase in osteoblastic
activity
 ON KIDNEYS-decreasing the reabsorption of
calcium-HYPERCALCIURIA
 ON INTESTINE-increases intestinal secretion

of water and electrolytes

 Inhibits intestinal absorption of calcium and

phosphate levels
 DISORDER :
 Ostoeporosis
Influence of Thyroid Hormones

 Thyroid hormones are important in skeletal

growth during infancy and childhood (direct
effects on osteoblasts).
 Hypothyroidism leads to decreased bone
growth.
 Hyperthyroidism can lead to increased bone
loss, suppression of PTH, decreased vitamin D
metabolism, decreased calcium absorption.
Leads to osteoporosis.
Effects of Glucocorticoids

 Normal levels of glucocorticoids (cortisol) are

necessary for skeletal growth.
 Excess glucocorticoid levels decrease renal
calcium reabsorption, interfere with intestinal
calcium absorption, and stimulate PTH
secretion.
 High glucocorticoid levels also interfere with
growth hormone production and action, and
gonadal steroid production.
 Net Result: rapid osteoporosis (bone loss).
Influences of Growth Hormone
 Normal GH levels are required for skeletal
growth.
 GH increases intestinal calcium absorption and
renal phosphate resorption.
 Insufficient GH prevents normal bone
production.
 Excessive GH results in bone abnormalities
(acceleration of bone formation AND
resorption).