Calcium

• Major elementsMajor elements
• Minor elementsMinor elements
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SourcesSources
• MilkMilk
– Cow’s milk – 100 mg/mlCow’s milk – 100 mg/ml
– Human milk – 30 mg/dlHuman milk – 30 mg/dl
• Egg, fish and vegetablesEgg, fish and vegetables
• Cereals.Cereals.

Daily requirement ofDaily requirement of
calciumcalcium
• Adults – 500 mg/day.Adults – 500 mg/day.
• Child – 1,200 mg/day.Child – 1,200 mg/day.
• Pregnancy & lactation – 1,500Pregnancy & lactation – 1,500
mg/day.mg/day.

Absorption of calciumAbsorption of calcium
• 11stst
and 2and 2ndnd
part of duodenum.part of duodenum.
• Helped by calcium dependentHelped by calcium dependent
ATPase.ATPase.
• Factors increasing rate ofFactors increasing rate of
absorption:absorption:
– Vitamin DVitamin D
– Parathyroid hormoneParathyroid hormone
– AcidityAcidity
– Amino acidsAmino acids

• Factors decreasing rate ofFactors decreasing rate of
absorption:absorption:
– Phytic acidPhytic acid
– OxalatesOxalates
– Malabsorption syndromeMalabsorption syndrome
– High phosphate contentHigh phosphate content

ExcretionExcretion
• Out of 500 mg of Ca taken orallyOut of 500 mg of Ca taken orally
per day, 400 mg is excreted inper day, 400 mg is excreted in
stool and 100 mg is excretedstool and 100 mg is excreted
through urine.through urine.

• Extracellular Ca concentrationExtracellular Ca concentration
2.5 mmol/l.2.5 mmol/l.
• Intracellular Ca concentrationIntracellular Ca concentration
< 10< 10 µµmol/l.mol/l.

FunctionsFunctions
1.1. Activation of enzymesActivation of enzymes
Ca++
+ Calmodulin
Ca-bound-Calmodulin
Kinase Active kinase
Enzyme Phosphorylated enzyme
Biological effectwww.indiandentalacademy.com

2.2. Mediates excitation andMediates excitation and
contraction of muscle fibers.contraction of muscle fibers.
3.3. Necessary for transmission ofNecessary for transmission of
nerve impulses.nerve impulses.
4.4. Ca-Calmodulin complex regulatesCa-Calmodulin complex regulates
micro-filament mediated processes.micro-filament mediated processes.
5.5. In myocardium, Ca prolongsIn myocardium, Ca prolongs
systole.systole.
6.6. Used in bone and teeth formation.Used in bone and teeth formation.
7.7. Ca and cAMP are secondCa and cAMP are second
messengers in different hormones.messengers in different hormones.
8.8. Secretion of hormones such asSecretion of hormones such as
PTH, calcitonin, vasopressin etc.PTH, calcitonin, vasopressin etc.
9.9. In blood coagulation.In blood coagulation.

Blood level of CalciumBlood level of Calcium
• 9 – 11 mg/dl.9 – 11 mg/dl.
Ionised form
Complexed with anions
Bound with proteins
5 mg/dl
1 mg/dl
4 mg/dl
Sulkowitch test

Factors regulating bloodFactors regulating blood
Ca levelCa level
1.1. VitaminVitamin
2.2. PTHPTH
3.3. CalcitoninCalcitonin
4.4. PhosphorusPhosphorus
5.5. Serum proteinsSerum proteins
6.6. Alkalosis and acidosisAlkalosis and acidosis
7.7. Kidney thresholdKidney threshold

HypercalcemiaHypercalcemia
• Blood calcium level more thanBlood calcium level more than
11mg/dl11mg/dl
• Major cause isMajor cause is
HyperparathyroidismHyperparathyroidism
causecause :parathyroid adenoma or:parathyroid adenoma or
an ectopican ectopic
PTH secreting tumorPTH secreting tumor

Signs:Signs:
• Osteoporosis and X-ray showsOsteoporosis and X-ray shows
punched out areas of bonepunched out areas of bone
resorption(osteitis fibrosaresorption(osteitis fibrosa
cystica generalitica or Von-cystica generalitica or Von-
Reckling hausen’s disease).Reckling hausen’s disease).
• Pathological fractures of bonePathological fractures of bone
• Hyperchloremic acidosisHyperchloremic acidosis

• Urinary calculiUrinary calculi
• Ectopic calcificationEctopic calcification
• Anorexia, muscle weaknessAnorexia, muscle weakness
• In blood, increase in calciumIn blood, increase in calcium
and alkalins phosphatase levelsand alkalins phosphatase levels
while phosphate level iswhile phosphate level is
lowered.lowered.

Minor causes of hypercalcemiaMinor causes of hypercalcemia
• Multiple myeloma, Paget’sMultiple myeloma, Paget’s
disease and metastaticdisease and metastatic
carcinomacarcinoma
• Milk alkali syndrome andMilk alkali syndrome and
vitamin D toxicity.vitamin D toxicity.
• Lethium therapy and thiazideLethium therapy and thiazide
diuretics.diuretics.

hypocalcemiahypocalcemia
Serum calcium level less thanSerum calcium level less than
8.8mg/dl8.8mg/dl
causescauses
• TetanyTetany
• Pseudo-hypoparathyroidismPseudo-hypoparathyroidism
• Renal tubular acidosisRenal tubular acidosis
• Fanconi’s syndromeFanconi’s syndrome

Calcium

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