CALCIUM HOMEOSTASIS

New insight : BIVEK SINGH

OBJECTIVE OF SESSION Calcium Body distribution of calcium Function of calcium Absorption and excretion of calcium Calcium homeostasis -hormonal regulation 1. Parathyroid hormone (PTH) 2. Vitamin D (Calcitriol) 3. Calcitonin

Calcium
Alkaline earth metal Atomic weight 20 Most abundant mineral in the human body

Body distribution
Total content inadult body is 25000mmol (approx. 1kg) 99% of calcium is found in bone extracellular fluid is 22.5 mmol Plasma calcium 1.protein bound fraction- 4-5mg/dl 2.complex with citrate and phosphate1mg/dl 3.ionised form- 4-5mg/dl

Major functions
Calcification of bone and teeth Muscle contraction Role in neuromuscular transmission Role in blood coagulation Calcium as second messenger

Absorption of calcium
Calcium is taken in diet principally as calcium-phosphate,carbonate or tartarate About 40% of the average daily dietary intake of calcium is absorbed in gut. Absorption of calcium by gut mucosa occur by energy dependent active transport process.

Excretion of calcium
Partly through kidney and mostly through intestine Renal threshold for serum calcium is 10mg/dl Excretion is increased in vitamin D deficiency

CALCIUM HOMEOSTATSIS Calcium homeostasis refers to the regulation of concentration of calcium ions in extracellular matrix Calcium homostasis is regulated by: 1. vitamin D (calcitriol) 2. parathyroid hormone (PTH) 3. calcitonin

Vitamin D (Calcitriol)
Vitamin D has two sources i.e. skin and diet 25-hydroxy cholecalciferol is the storage form of vitamin D in liver 1,25-hydroxy cholecalcitriol is the active form of vitamin D Activated by PTH and hypophosphptemia through 1alpha hydroxylase enzyme in kidney

VITAMIN D SYNTHESIS
SKIN
7-DEHYDROCHOLESTEROL h VITAMIN D3

LIVER
VITAMIN D3
25-HYDROXYLASE

KIDNEY
25(OH)VITAMIN D
1-HYDROXYLASE

25(OH)VITAMIN D

1,25(OH)2 VITAMIN D (ACTIVE METABOLITE)

TISSUE-SPECIFIC VITAMIN D RESPONSES

Action of Calcitriol on intestine

Calcitriol stimulates the absorption of dietary calcium and phosphate . Calcitriol induces the synthesis of calcium binding proteins(Calbindin D) in the enterocytes. Thus increases the uptake of calcium by intestine.

Action of calcitriol on bone

Calcitriol along with parathyroid hormone stimulates the osteoclastic bone resorption

thus,mobilization of calcium and phosphate from bone.

Action of Calcitriol on the Kidney Calcitriol reduces the excretion of calcium and phosphate through the kidney.

Increase reabsorption.

Parathyroid hormne
4 parathyroid glands Release PTH in response to drop in serum calcium Magnesium needed to activate PTH release Effects on bone, kidney and

Action of PTH on bone

PTH causes resorption of bone by osteoclastic activity Due to increased stimulation of pyrophosphatase and collagenase This causes the mobilization of calcium from bone Increase blood calcium level

Action of PTH on kidney

Increased reabsorption of calcium from kidney tubule Reduce the excretion of calcium Helps in synthesis of calcitriol by 1-alpha hydroxlase enzyme

Action of PTH on intestine

Indirectly By promoting synthesis of calcitriol

CALCIUM, PTH, AND VITAMIN D FEEDBACK LOOPS

BONE RESORPTION URINARY LOSS 1,25(OH)2 D PRODUCTION RISING BLOOD Ca SUPPRESS PTH

NORMAL BLOOD Ca
FALLING BLOOD Ca BONE RESORPTION URINARY LOSS 1,25(OH)2 D PRODUCTION STIMULATE PTH

Calcitonin

Secreted by parafollicular cells of thyroid gland Metabolism is antagonistic to PTH hormone Normal concentration in plasma is 10-20 pg/ml

 Mainly acts on osteoclasts

Action of calcitonin on bone & kidney

Reduces osteoclastic activities by reducing number and size of osteoclasts.Thus, inhibits bone resorption On kidney, it decreases calcium reabsorption from kidney Causes calciuria

CALCIUM HOMEOSTASIS
DIETARY CALCIUM THE ONLY IN
DIETARY HABITS, SUPPLEMENTS

BONE
ORGAN, ENDOCRINE

BLOOD CALCIUM KIDNEYS

ORGAN PHYS. ENDOCRINE PHYS.

INTESTINAL ABSORPTION
ORGAN PHYSIOLOGY ENDOCRINE PHYSIOLOGY

URINE THE PRINCIPLE OUT

Questions !!!!!!!!! or suggestions ?????? biveksingh@hotmail.com BIVEK SINGH KIST MEDICAL COLLEGE LALITPUR,NEPAL