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Minerals
Shajan xaviour
Minerals
A naturally occurring , homogeneous,
inorganic substance required by humans in
amts of 100 mg/day or more
-functions
-high and low serum levels
-absorption
-excretion
-deficiency
-toxicity
Minerals in a 60-kilogram (132-pound) Human Body
TRACE MINERALS
There are more than a dozen trace minerals,
although only six are shown here.
Amount (g)
MAJOR MINERALS
The major minerals are those present in amounts
larger than 5 g (a teaspoon). A pound is about
454 g; thus only calcium and phosphorus appear
in amounts larger than a pound.
calcium
Calcium
-most abundant mineral in the body
-99% of calcium is in the bones and teeth
-the remaining 1% is in the blood and ECF in
cells and soft tissues
Skeletal Calcium
-if there is no reserve, calcium is drawn from bone—leading to deficiency
Serum levels: 8.8 to 10.8 mg/dl
**when albumin is low (malnutrition,
liver dz), calcium is decreased
Ratio: for each gram albumin is
decreased below 4, add 0.8 to calcium
-ionized calcium is increased in acidosis and decreased in alkalosis (increased bicarb binds calcium)
***-example: in resp alkalosis, total serum calcium is normal, but ionized is low—always check ionized level with acid/base disorders
Functions
-building and maintaining bones and teeth
-transportation of cell membranes and membrane stabilizer
***-nerve transmission and regulation of heartbeat—use calcium gluconate IV to treat hyperkalemia (EKG—peaked T waves)
-ionized form initiates formation of the blood clot
-cofactor in conversion of prothrombin to thrombin
-required for muscle contraction
Regulate permeability of capillary walls
Regulate citric acid cycle
Absorption
-***absorbed mainly in the acidic part of the duodenum
-absorption is decreased in the lower GI tract which is more alkaline
20-30% of digested calcium is absorbed
Absorption is affected when Vit D is deficient
-unabsorbed form is excreted in feces
Factors that increase calcium
absorption
-***more efficiently absorbed when the body is deficient
-best absorbed in acidic environment (upper duodenum)
-HCL in stomach allows better absorption in the proximal duodenum
-taking calcium with food increases abs
-fat increases intestinal transit time and increases absorption
Factors that decrease
absorption
-***lack of vitamin D
-oxalic acid forms insoluble complex which decreases absorption (rhubarb, spinach, chard, beet greens)
-phytic acid found in outer husks of cereal grains also form insoluble complex
-alkaline medium decreases abs.(lower GI tract)
Aging decreases absorption
Maintenance of serum level
-parathormone (PTH) by the parathyroid gland and thyrocalcitonin secreted by the thyroid gland maintain serum levels
-***with decreased serum calcium levels, PTH increases and causes transfer of calcium from bone to blood to increase serum levels
-decreased levels also cause kidney to reabsorb calcium more efficiently (might normally be excreted in the urine) and to increase intestinal absorption
-when blood levels are increased, calcitonin acts by the opposite mechanisms as PTH to decrease serum levels
Maintenance of serum level
cont’d
***-always need to correct low Mg level
before treating a low calcium level
-hypomagnesemia decreases tissue
responsiveness to PTH
Causes of hypocalcemia
-***malabsorption
-small bowel bypass, short bowel
-vit D deficiency
-alcoholism
-***chronic renal insufficiency
-***diuretic therapy
Causes of hypocalcemia
cont’d
-hypoparathyroidism
-***hypomagnesemia
-sepsis
-pseudohypoparathyroidism
-calcitonin secretion with medullary
carcinoma of the thyroid
Causes of hypocalcemia
cont’d
-***associated with low serum albumin
(ionized calcium will be wnl)
-decreased end organ response to vit D
-hyperphosphatemia
-***aminoglycosides, plicamycin, loop
diuretics, foscarnet
Causes of hypercalcemia
-milk-alkali syndrome
-vit D or vit A excess
-primary hyperparathyroidism
-secondary hyperparathyroidism (renal insuff, malabsorption)
-acromegaly
-adrenal insufficiency
Causes of hypercalcemia
cont’d
***Neoplastic Disease
-tumors producing PTH-related proteins (ovary, kidney, lung)
-***mets to bone
-lymphoproliferative disease including multiple myeloma
-secretion of prostaglandins and osteolytic factors
Causes of hypercalcemia
cont’d
-***thiazide diuretic
-sarcoidosis
-paget’s disease of bone
-***immobilization
-familial hypocalciuric hypercalcemia
-complications of renal transplant
-iatrogenic
Excretion
-normal is 65-70% of ingested calcium
to be excreted in the feces and urine
-strenuous exercise increases loss (in
sweat)
-***immobility with bed rest and space
travel increase calcium loss because of
lack of bone tension
RDA
-see handout
sources
Deficiency
1)***bone—to be discussed in osteoporosis lecture
2) tetany—decreased serum levels increase the irritability of nerve fibers resulting in muscle spasms, fatal laryngospasm ***-Chvostek’s sign: contraction of the facial m.
after tapping the facial n.
***-Trousseau’s sign: carpal spasm after occlusion of the brachial a. with blood pressure cuff for 3 min
3) HTN—controversial
4) prolonged QT--arrythmias
Toxicity
-***polyuria, constipation, bone pain,
azotemia, coma
-”stones, bones(bone pain), groans,
psychiatric overtones”
Phosphorus
Levels maintained by parathyroid gland
Functions -structure of teeth and bones
-essential component in cell
membranes, nucleic acids,
phospholipids
-phosphorylation of glucose
-buffer system in ICF and kidney
Major role in A/B balance
Essential for lipid metabolism &CHO
Cell division and protein synthesis
absorption
-best occurs when calcium and phos are
ingested in equal amts (milk)
-vit D also increases absorption
Sources
***dietary sources should be restricted in renal disease (usually see increased phos, decreased Ca)
-protein sources
-meat, poultry, fish, eggs, legumes, nuts, milk, cereals, grains
RDA
1-1.5 Mg/day
Causes of hypophosphatemia
-starvation
-TPN with inadequate phos content
-malabsorption, small bowel bypass
-vit D deficient and vit D resistant
osteomalacia
Causes of hypophosphatemia
cont’d
-phosphaturic drugs: theophylline, diuretics, bronchodilators, corticosteroids
-hyperparathyoidism (primary or secondary)
-hyperthyroidism
-renal tubular defects
-hypokalemic nephropathy
-inadequately controlled DM
-***alcoholism
Causes of hyperphosphatemia
-excessive growth hormone
(acromegaly)
-hypoparathyroidism assoc with low Ca
-pseudohypoparathyroidism assoc with
low Ca
-***chronic renal insufficiency
-acute renal failure
Deficiency
-fatal
-usually rare with food intake
-***respiratory muscle collapse
-heart failure
-muscle aches, bone pain, and fracture
Magnesium
Function
-bone, muscle contractility, nerve
excitability
-antagonistic to calcium
--in a muscle contraction, Mg relaxes, and
calcium contracts
--low Mg can cause pregnancy induced
HTN
Absorption / Excretion
-absorption varies
-similar to calcium (low pH, upper GI), however, no Vit D required-kidney conserves Mg when intake of Mg is low
-large losses with vomiting because of high levels of gastic juice
sources
Sources
-seeds, nuts, legumes, unmilled cereal
grains, dark greens
-fish, meat, milk, fruits
-lost during refining of flour, rice, vinegar
Causes of hypomagnesemia
-malabsorption, chronic diarrhea, laxative abuse
-prolonged GI suction
-small bowel bypass
-malnutrition
-***alcoholism
-refeeding
-TPN with inadequate Mg
Causes of hypomagnesemia
cont’d-DKA
-diuretics
-hyperaldosteronism, Barrter’s syndrome
-hypercalcuria
-renal Mg wasting
-hyperparathyroidism
-postparathyroidectomy
-vit D therapy
-aminoglycosides, ***cisplatin, ampho B
Causes of hypermagnesemia
Decreased renal fxn
***Increased intake—abuse of Mg
containing antacids (MOM) and
laxatives in renal insufficiency
Deficiency
-anorexia, growth failure, cardiac and
neuromuscular changes—weakness,
irritability, mental derangement
-tetany, muscle cramps
Toxicity
-respiratory—depression, apnea
-CV—hypotension, cardiac arrest, EKG (prolonged QRS and QT, heart block, peaked T waves)
-GI—N/V
-neuromuscular—paresthesias, somnolence, confusion, coma, hyporeflexia, paralysis, apnea
Iron
Function
-respiratory transport of O2 and CO2
-immune system
-cognitive performance
-found in Hgb (in RBC’s) and myoglobin
(in muscles)
-cytochrome p450 system
Absorption and transport
-dietary iron exists in heme (Hgb and myoglobin) and non-heme
-***heme Fe is absorbed better
-non-heme Fe has to be present in the duodenum or upper jejunum in soluble form if it is to be absorbed
-in Fe deficiency, 50% can be absorbed
-***2-10% of Fe from veggies is absorbed and 10-30% is absorbed from animal protein
2 types
Heme proteins-
Hgb,Mb,Cytochromes,Catalases,Perioxi
dase
Non Heme Proteins
Ferritin,Hemosiderin,Transferrin,Iron
sulphur proteins,Aconitase
Factors affecting absorption
-***ascorbic acid is the most potent enhancer
-animal proteins (beef, pork, veal, lamb, liver, fish, chicken) enhance
-but, proteins from cow’s milk, cheese, eggs, don’t
-gastric acidity enhances absorption (antacids interfere)
-pregnancy, increased growth, Fe defic all increase deficiency
-phytate and tannins decrease abs
-Fatty acids
-increased intestinal motility decreases
absorption because it decreases
contact time for absorption
Storage
-stored as ferritin and hemosiderin
-long term high Fe ingestion or frequent blood transfusions can lead to accumulation of Fe in the liver
-***hemosiderosis develops in individuals who consume a lot of Fe or have a genetic defect resulting in increased Fe absorption
-in associated with tissue damage, it is called hemochromatosis
Excretion
-lost thru bleeding, feces, sweat,
exfoliation of hair and skin
-none in urine
Sources and Intakes
-best source is liver
-oysters, shellfish, kidney, lean meat, poultry, fish
-dried beans, veggies, dark molasses
-egg yolks, dried fruit, enriched breads,
-requirements are highest in infancy and adolescence
-females stay high because of menstruation
-decrease with menopause and increased with pregnancy
RDA
Man and post.mp-10-30 mg/day
PMp-20-40
Children 15-50 mg
Preg &lactation-18-36
Deficiency
-most common deficiency
-most at risk: <2 yrs old, teens, pregnancy, elderly
-***anemia (hypochromic, microcytic)
-tx: diets high in absorbable Fe and/or Fe supplements (ferrous sulfate, ferrous gluconate)
-can be caused by injury, hemorrhage, illness, poor diet
COPPER
Total body Cu is 100 mg
Sources
Liver,fish,meat ,nuts but milk is a poor
source
RDA
2-3 mg/day
Functions of Cu
Mobilization of iron ie fe2+ to Fe 3+
Formation of enzymes like Dopamine
oxidase,MAO,Serum Ferroxidase,
Cytochrome Oxidase,etc
Hb,Elastin(Elastin is a protein in connective tissue that is
elastic and allows many tissues in the body to resume their
shape after stretching or
contracting),Melanin,Catacholamine etc
Deficiency
Microcytic anaemia(types of anemia
characterized by small red blood cells
(called microcytes)
Over consumption can leads to V/D
Clinical significance
Wisons disease or hepato lenticular
degeneartion
Excess deposition of Cu in liver, brain
leads to kayserFleisure ring
Menkes Disease
Its due to defect in absorption of copper
Symptoms:
Copper in urine and Plasma, anaemia
and depigmentation of skin and hair
Zinc
-involved in synthesis or degradation of CHO, proteins, lipids, nucleic acids
-stabilizes RNA and DNA
involved in transcription and replication
-needed for bone enzymes and osteoblastic activity
absorption
Impaired absorption in Crohn’s or
pancreatic insufficiency
-plasma zinc levels act as acute phase
reactants and fall by 50% with injury
(like platelets)
Inhibiting Factors
-fiber, phytate
-high doses of copper
-Fe competes with zinc for absorption
Enhancing Factors
-glucose, lactose, and soy protein
-red wine
-human milk
Excretion
-feces—almost entirely
-***in urine with starvation, nephrosis,
DM, alcoholism, hepatic cirrhosis (zinc
supplementation in encephalopathy),
porphyria
Sources and Intakes
-meat, fish, poultry, milk
-oysters, shellfish, meat, liver, cheese,
whole grains, dry beans, nuts
Deficiency
-short stature, hypogonadism, anemia
-with diets high in unrefined cereal and
unleavened bread
-delayed wound healing, alopecia
***-acrodermatitis enteropathica=AR dz with
zinc malabsorption
-eczematoid skin lesions, alopecia, diarrhea,
bacterial and yeast infections, death
-immunologic deficits—lymphopenia,
thymic atrophy
***Causes of
deficiency Anorexia Nervosa
TPN without zinc (diarrhea, small bowel fistulas)
High intake of phytate, tannins, binding drugs (EDTA), oxalate
High iron intake
Malabsorption syndromes
Acrodermatitis enteropathica
Diarrhea
Pancreatico-cutaneous fistula
Proximal entero-cutaneous fistulas
Hemolytic anemias (sickle cell anemia)
Renal failure patients on dialysis
***Zinc Deficiency
42 yo female with chronic uremia on dialysis. Recently started
on iron supplement for anemia. Presents with rash,
hypogeusia, hyposmia and poor dark adaptation.
Acrodermatitis
Enteropathica
Autosomal recessive disease
associated with a defect causing a
reduction in zinc absorption
Can be treated by pharmacologic
doses of oral zinc
Acrodermatitis
Enteropathica
Toxicity
->100-300 mg/d
-rare
-interferes with copper absorption
-decrease in HDL
-GI irritation, vomiting
Fluoride
-tooth enamel
-resistance to dental caries
-fluoridation of h20 has decreased
caries by half
-found in drinking h20, teflon pots and
pans (cooked in these)
-toxicity at doses >0.1 mg/kg/d
Intervention studies have demonstrated water supplementation reduces prevalence of caries
***Incidence of dental fluorosis (mottled
teeth) occurs with increased intake
above 1-2 ppm.
Functions
-Prevention of Dental caries /tooth
decay(fluoride helps to form fluroapatite of enamel and
dentine this is more resistant against acids ,plaques etc)
-Bone development
Mottled teeth in fluorosis
Deficiency
If the consumtipn less than 0.5 ppm can
leads to dental caries and also
osteoporosis
Note:- topical application of fluoride will
result in the formation of fluroapatite
layer on the enamel which prevent
decay of tooth.
excess
If Excess amount can leads to Flurosis
Dental flurosis and Skeletal flurosis
Dental flurosis- If intake is above 2ppm
Discoloration of teeth, teeth become
rough and yellow patches on surface
Skeletal flurosis:-If intake is above 20
ppm will leads to Hyper calcification,
increase density of bones of limb, pelvis
and spine.
Dental F Skeletal F
Maganese
-found in many enzymes
-connective and bony tissue formation
-growth and reproduction
-CHO and lipid metabolism
Absorption and Excretion
-after absorption, it appears rapidly in
the bile and is excreted in the feces
-concentrated in liver and increases with
liver disease
Sources and Intakes
-whole grains, legumes, nuts, teas, fruit,
veggies, instant coffee, and tea
RDA- 5-6mg/day
functions
Manganese is an integral part of glycosyl
transferase responsible for synthesis of
glyco proteins and chondrotin sulphate
Mn has a role in cholestrol synthesis
Mn needed for RNA polymerase(RNA
polymerase (RNAP or RNApol) is an
enzyme that produces RNA) activity
Mn is required for formation of Bones,
Skeletal development, Proper
reproduction, blood clotting and noramal
nervous functioning
Mn required for Hb synthesis
Deficiency
-wt loss, ataxia, dermatitis, N/V,
decreased hair growth, impaired
reproductive activity, decreased
pancreatic function and CHO
metabolism
Toxicity
-accumulates in liver and CNS—
parkinsonian sx