Asst professor Bldeas shri b m patil institute of nursing sciences vijayapur Minerals Introduction Minerals are inorganic substances that play an important role in a ID: 921155
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Slide1
Mr. sankappa gulaganjiAsst professorBldea’s shri b m patil institute of nursing sciences, vijayapur
Minerals
Slide2Introduction Minerals are inorganic substances that play an important role
in
a
variety
of
metabolic reactions, as cofactors. They
form one of
the essential components
of the
diet.
M
i
ner
a
l
s
a
r
e
e
s
sent
ia
l f
o
r
no
r
m
a
l
gr
o
w
th
a
n
d
maintenance of the
body.
They are essentially
divided
into two major groups:
Slide3Groups 1. Macronutrients which are required in large amounts they are also called as major elements and Requirement >100
mg
/day,
such as
Calcium,
Magnesium
Sulphur
Sodium
Potassium and
Chloride Etc
Slide4Conti…2. Micronutrients which are required in very small quantities
in the
diet.
Requirement <100mg/day
Trace Elements:
Those recognized as essential for human nutrition and for which sufficient information
is
available
to
justify
the
recommended dietary allowances (RDA) such as Zinc,
Iodine
and Iron
Those
probably
essential
for
human
nutrition
(known
to
be
essential
in
animals,
but
insufficient information
is
available regarding humans). Examples: Copper, molybdenum, fluorine, selenium, cobalt, chromium and manganese
Slide5Conti….So
m
e
a
r
e
n
ec
e
s
sar
y
f
o
r t
h
e b
o
dy
b
ut their
exa
c
t
functions are
not
known.
Ex: Nickel, Bromide,
Lithium, Barium
Non-Essentials
:
seen
in
tissues. Contaminants
in
food
stuffs.
Ex.:
Rubedium
,
Silver,
Gold,
Bismuth
Toxic
:
should
be
avoided.
Ex.:
Aluminium
,
Lead, Cadmium,
Mercury
Slide6SodiumSodium is the
e
l
ec
trolyte
w
hi
c
h is
f
ound in l
a
rge
a
m
ount in
extracellular fluid
compartments
Sources:
Sodium
is
widely distributed
in
natural
foods.
It is
present in table
salt.
Large amounts are found
in
cheese and
butter.
Daily requirement:
Adult
: 0.5 g
Children
: 1g .Serum
level 136-146mmol/L
Slide7Conti…Absorption:Sodium
is
absorbed with
the help of the
sodium pump,
involving
Na
+
,
K
+
-
ATPase
.
Active absorption
of
Na
+
is
often coupled with energy generated by metabolism
of
glucose
or
amino
acids.
Slide8Functions of SodiumFluid balance: Maintains osmotic
equilibrium.
Acid-base balance.
Na
+
and
H
+
exchange
occurs in the
kidney and
is involved in the
maintenance
of
acid-base
balance.
Neurotransmission: Sodium
is involved in the
maintenance
of the
resting membrane potential and also
in the propagation of the
action potential.
Role
in
muscular excitability. Along with
other
cations
such as potassium, neuromuscular
irritability.
Maintenance
of
viscosity
of
blood.
Sodium
and
potassium
regulate
the
degree
of
hydration
of the
plasma proteins and maintains
the
viscosity
of
blood.
Slide9Excretion and RegulationExcretion:
Sodium
is
excreted via
the
kidneys and
skin.
Regulation:
A
ldo
s
t
e
rone
,
R
en
i
n
-
ang
iot
en
s
in
s
y
s
t
e
m
,
Kinins
an
d
P
ro
s
t
ag
l
and
ins
regulate
sodium
homeostasis.
Slide10HypernatraemiaIt occurs due to the presence
of high
amounts
of
sodium.
It is
less common
than
hyponatraemia
.
It
cou
ld be due to
h
y
p
e
r
ac
tivity of
ad
r
ena
l
c
o
rt
e
x (
C
u
s
hing’s
syndrome),
or
prolonged administration
of
corticosteroids.
Hypernatraemia
may also
be due to
an overenthusiastic, intravenous administration
of
saline.
Water
can
be
retained
along
with
sodium
and
the
patient
may
show
puffiness
of the
face.
Slide11HyponatraemiaIt occurs in the following conditions :
Gastroenteritis with
diarrhoea
and
vomiting
Severe
burns
Small
gut
obstruction
Addison’s disease
Use
of
mercurial
diuretics.
Slide12PotassiumPotassium is
the
major
intracellular
cation
.
It
is
widely
present
in
the
body
fluids and
tissues.
Sources
It is
most widely distributed
in
vegetables.
Daily requirement:
Adult
: 2-4
gms
Children
: 1-3
gms
.Serum
level
3.5-5.1mmol/L
Slide13AbsorptionPotassium is easily
absorbed.
Potassium exhibits
a
tendency
to
diffuse against concentration gradient from
the
intracellular
to the
extracellular fluid. The sodium pump transports potassium
into the
cells.
Slide14ExcretionIt is excreted in the urine.
The amount excreted
is dependent on the sodium
intake.
It
is
excreted
via
the
gastrointestinal
tract,
saliva,
pancreatic
and
intestinal juices and
faeces
.
Small amounts are lost
via
skin as
sweat.
Slide15Functions Some of the
functions
of
potassium are same as those
of
sodium.
Serum potassium concentration
does not vary
appreciably
in
response
to
water loss
or
retention.
Cellular uptake
of
potassium
is
stimulated
by
insulin.
Helps
in
maintaining Acid-base balance.
A
reciprocal relationship exists between potassium and hydrogen ions. As acidosis develops, potassium
ions
are disposed from
the
cells
in order to
maintain
electroneutrality
. Thus potassium
is involved in
acid-base
balance.
It is
important
in
cardiac and muscular functions. Too
high
or
too low
concentration
of
potassium
may
have
life-threatening
consequences.
Helps
in
enzyme action. An enzyme such as
pyruvate
kinase
requires
K
+
as
a
cofactor.
Like
sodium,
it is
also
involved in
neurotransmitter.
Slide16Conti…Applied aspects:
Extracellular levels
of
potassium are measured
in
serum.
Hemolysis
and allowing
the
serum sample
to
stand for very
long, produces
changes
in the
potassium
values
So,
the
sample should
be
analyzed as soon as
possible.
Slide17HyperkalemiaCauses-The kidneys may
not be
able
to
excrete
a
potassium
load
when
glomerular
filtrate
is
low. Acidosis aggravates
the
problem.
In
addison’s
disease
and
adrenalectomy
,
high
levels
of
potassium
are
observed.
Potassium
is
released from damaged
cells.
Slide18Conti…Clinical symptoms
:
Muscle
weakness
Hyperkalaemia
can cause sudden
death
as cardiac arrest
is the
first manifestation.
It
lowers
the
resting membrane potential, shortens cardiac action potential and increases
the velocity of
repolarization
.
It is
therefore necessary
to be
alert.
Management
:
Infusion
of
insulin and
glucose.
Infusion
of
calcium
gluconate
may also counteract
the
effect
of
hyperkalemia
.
Dialysis
is
sometimes
necessary.
Slide19Hypokalaemia Causes
Gastrointestinal losses,
diarrhoea
, vomiting or surgical
fistula.
Renal diseases, administration
of
diuretics and increased
aldosterone
production.
Administration
of
diuretics and
corticosteroids.
Alkalosis which shifts potassium from the extracellular fluid
to the
intracellular fluid
Slide20Conti…Clinical symptoms
Neuromuscular weakness and
hypotonia
Cardiac arrhythmias,
digoxin
toxicity and changes
in
ECG.
Impaired concentrating ability
of the
kidneys leading
to
polyuria
and
polydypsia
.
Metabolic
alkalosis
Slide21Conti…Management :
Oral administration
of
salts
is
given
in
an enteric coating because potassium salts are
unpleasant.
Intravenous potassium can
be
given.
Applied
aspect:
In
t
r
avenou
s pot
a
s
s
ium
s
hould be given
s
lo
w
ly
an
d under E
C
G
monitoring except
in
extreme
cases.
Slide22Calcium (ca)Total Calcium in human body: 1 – 1.5
K
g
In
Bones –
99
%
In extra cellular fluid
– 1
%
Sources
:
Milk
(Cow’s
Milk –
100mg/100ml)
Egg,
Fish,
Vegetables
-
moderate
Cereals
(wheat,
rice) - poor
source
Slide23Daily requirement Population Daily requirement
Adults
1200 mg/day
Children
1500 mg/day
Pregnancy & Lactation
1500 mg/day
>50 years(older people)
1500 mg/day
+
20µg
Vit.D
(to prevent osteoporosis)
Slide24Factors promoting &inhibiting ca absorptionPromoting factors
Inhibiting factors
Vitamin-D (
calcitriol
)
c
a
r
r
ie
r
pro
t
e
i
n
calbidin
P
h
y
ta
t
e
s
a
n
d
o
xa
l
a
t
e
s
Parathyroid hormone
H
i
g
h
d
i
eta
r
y
p
h
o
sp
h
a
t
e
s
Acidity
High pH
Amino
acids
–
Lysine
and
Arginine
High dietary
fiber
Mal absorption
syndrome
Slide25Functions Bones and teeth formationMuscle contraction:
C
a
i
n
t
e
r
ac
t
s
w
i
t
h
T
r
opon
i
n
-c to trigger
muscle
contraction. Ca activates
ATPase
,
↑
interaction between
actin
and
myosin. Ca mediates the excitation & contraction of
mucles
.
Nerve conduction
:
Transmission
of
nerve
impulses
from
pre-
synaptic to
post-synaptic
region.
Secretion
of
hormones
:
M
ed
i
a
t
es
t
he
s
e
c
r
e
t
i
o
n
o
f
In
s
u
li
n
, P
T
H
,
Calcitonin
,
Vasopressin
etc
.
Conti…Second Messenger
:
C
a &
c
yclic AMP
a
r
e
2
n
d
m
esse
n
ge
rs
o
f
different
hormones.
Eg
:
Glucogan
Membrane integrity
&
Permeability
:
Infl
u
e
n
ce
s
t
r
ansp
or
t
o
f
nu
m
b
e
r
o
f substances across
the
membranous
barrier.
Blood Coagulation
:
Factor IV in
blood coagulation cascade.
prothrombin
→
Thrombin
Action on
Heart
:
Ca prolongs
Systole ↑
C
a
conc
e
n
trati
on →
contractility
.
Slide27Conti…Activation of
Enzymes
:
Calmodulin
–
Ca binding
regulatory protein.
Binds
with
4
Ca ions
and leads
to activation
of
enzymes.
Slide28Normal Calcium Values
Normal
Plasma
/
Serum
Calcium
9 –
11
mg
/
dl
Ionized
Calcium
5
mg/dl
Protein
bound
Calcium
4 – 5
mg/dl
Complexed
with
phosphate/citrate/ bicarbonate
about
1
mg/dl
Slide29Slide30HypercalcaemiaDeficiency of calcium leads to ricke
t
s
, o
s
t
eopo
ro
s
i
s
,
and
hyperexcitability
.
Hypercalcaemia
:
It
may
occur in the
following
conditions:
Hyperparathyroidism
Multiple
myeloma
Metastatic carcinoma
of
bone
Milk-alkali syndrome
Treatment with drugs such as
diuretics
Hypervitaminosis
D
Slide31HypocalcaemiaHypocalcaemia:It is
observed
in:
Tetany
Hypoparathyroidism
Fanconi’s
syndrome (disorder
of
tubular
reabsorption
)
Acute
pancreatitis
Vitamin
D
deficiency
Chronic renal failure
Slide32Applied aspectsApplied
aspects:
If the
level
of ionic
calcium falls,
the nervous
system becomes hyperirritable.
This could lead
to
tetany
. On
the other hand, high
calcium content depresses
nervous
irritability. Thus,
the
administration
of
calcium salts
is
indicated in
the
alleviation
of
tetany
.
Slide33ChlorineChlorine is the principle extracellular anion.
Its
plasma concentration tends
to
follow
that of
sodium.
Sources:
Chlorine
is
present
in
table
salt.
Many vegetables and meats contain
chloride
Water
is
also
“chlorinated”.
Daily requirements:
Adults
:
2-5
gms
Children
: 0.5 – 2
gms
.Serum level
98-106mmol/L
Slide34Absorption, Excretion & RegulationAbsorption:
Occurs
in
small
intestines.
High renal
threshold.
Excretion:
Through sweat,
faeces
and
urine.
Regulation:
Chloride levels
in
plasma are directly proportional
to sodium
ions, whereas they are inversely related
to the
bicarbonate
concentrations.
Slide35FunctionsFunctions:
Important
in
gastric juice as
part of the
gastric
hydrochloride.
Involved in the
chloride shift. It
is
involved
in
the maintenance
of
intracellular homeostasis
in the
RBCs.
Slide36Hyperchloraemia & Hypochloremia
Hyperchloraemia
:
It
can
be
caused
by
chloride
gain
and
vomiting.
It
may
be
associated with
hypematraemia
, metabolic alkalosis and
repiratory
acidosis.
Hypochloremia
:
Metabolic alkalosis which
is
saline responsive occurs. It
occurs
during vomiting, diuretic therapy, injection
of
alkali and
diarrhoea
.
Metabolic
alkalosis
can
also
be
saline
nonresponsive.
It
occurs
during
mineralocorticoid
excess and severe
K
+
deficiency.
Slide37PHOSPHORUSTotal body phosphate weighs about 1 kg, 80% of which
is
present
in bone
and teeth while 10%
is in
muscles.
Sources:
Cheese, milk, nuts, eggs,
etc.
Daily requirement:
Adults
: 500
mg
Pregnant women
: 1
gm
Children:
400 –600
mg. Serum level
0.8-5.1mmol/L.
Absorption:
Absorption
of
phosphate
is
stimulated
by
parathormone
(PTH) and vitamin
D
3
.
The absorption
is
mainly from
jejunum.
Slide38Functions:Phosphate is
an important constituent
of bones
and
teeth.
It is needed
for
the
production
of
high-energy phosphates such as
ATP,
CTP, GTP and
creatinine
phosphate.
DNA and RNA
have
phosphate
diester
linkages
that form the backbone of the
structure.
Certain enzymes are activated by
phosphorylation
Phospholipids,
phosphoproteins
, lipoproteins, nucleotides contain phosphate as
one of
their
components.
Slide39Regulation of calcium and phosphorus:Regulation
depends
on:
Vitamin D. Intestinal absorption
of
calcium and phosphorus
is
increased by vitamin D. It promotes mineral deposition
in bones
and phosphate
reabsorption
in
kidneys.
Calcitonin
.
It
lowers serum calcium and phosphorus.
It
reduces mobilization from bones.
PTH increases serum calcium and lowers
phosphorus.
Calcium: Phosphorus ratio
is
important. There
is
reciprocal relationship between serum calcium and phosphorus. Rise
in
calcium
or
phosphorus
is
accompanied
by
fall
in the other
ion.
Estrogens and testosterone promote retention and deposition
of
calcium
in
bones.
In
women, osteoporosis
in
which, delayed recovery from fractures
are
observed after
menopause.
Serum level
of
phosphate required by adults
is
3-4 mg/day, while normal children require
5-6
mg/day.
Slide40Clinical manifestationsDeficiency of phosphorus results
in
osteomalacia
, renal rickets and cardiac
arrhythmia.
Hyperphosphataemia
:
It is
observed in:
Diabetes mellitus,
starvation
Renal
insufficiency
Hypothyroidism
Hypervitaminosis
D
Slide41Hypophosphataemia:It is
seen
in:
Rickets
Fanconi’s
syndrome
Intake
of
drugs such as
antacids
Slide42Applied aspectsThe whole blood phosphate
is
about
40
mg
/
dl.
RBCs and WBCs contain
a lot of
phosphate.
Hemolysis
should
be
prevented when
blood is
taken for phosphate estimation.
Slide43MAGNESIUMMagnesium is
found
both
in
intracellular
and
extracellular
fluids.
Total
body
magnesium
is
about
20 g, 75% of
which
is
complexed
with calcium
in bone.
Source:
Green vegetables, potatoes, almond, cheese, cereals,
beans
and almost all animal
tissues.
Daily requirement:
Adults
: 350
mg
Pregnant women
: 450
mg
Children:
150
mg. Serum level
0.7-1.0mmol/L.
Slide44Absorption:Absorption of
magnesium takes place primarily
in the
small bowel
by a
specific carrier
mechanism.
Factors which increase
the
absorption
of
magnesium are vitamin D,
PTH, high-protein intake, neomycin
therapy.
Factors which decrease the absorption are increased calcium intake, fatty acids,
phytates
and
phosphate.
Slide45Functions:Involved in enzyme action. Magnesium
is the
cofactor
of
many
enzymes requiring ATP. Alkaline
phosphatase
,
hexokinase
,
fructokinase
,
adenylate
cyclase
,
cAMP
-dependent
kinase
need
magnesium. Magnesium forms
ATP-Mg
2+
complexes and
binds to the
enzymes.
Required in neuromuscular
activity.
An important constituent
of bone
and
teeth
Normal serum
blood
level
is
2-3 mg/
dl
(1-1.5
mol/l).
Slide46Clinical manifestations:Deficiency of magnesium causes muscular tremor, confusion,
vasodilation
and
hyperirritability.
Hypermagnesaemia
is
observed
in:
Hypothyroidism, Diabetic
mellitus, Acute renal failure
Hypomagnesaemia
is
seen
in:
Hyperthyroidism, Chronic
alcoholism,
Malnutrition, Prolonged use
of
diuretics, Portal cirrhosis
Toxicity
due to the
increased use
of
magnesium-containing laxatives and antacids
has been
reported
in the
elderly. The chief symptoms are drowsiness, lethargy and
weakness.
Slide47SULPHURProteins contain
about
1%
sulphur
by
weight.
This
forms
the
organic
sources
of
sulphur
in the
diet.
Sulphates
of sodium ,
potassium and magnesium are also found
in the
diet.
Source:
Meal, fish
legums
, eggs, cereals and
cauliflower.
Daily requirement:
Adequate intake
of
protein fulfills
the
sulphur
requirements.
Slide48Absorption:Sulphur –containing amino acids
produce inorganic
sulphur
.
A part of it is
conjugated with
phenolic
and heterocyclic compounds
in liver to
produce ethereal
sulphates
.
It is
secreted
in
urine
as:
Inorganic
sulphur
Neutral
sulphur
Ethereal
sulphur
Intestinal putrefaction causes increased ethereal
sulphates
.
Slide49Excretion & FunctionsExcretion:Sulphate
excretion increases when catabolism
of
tissues protein
is
increased.
Functions:
Detoxication
. Compounds possessing
phenolic
groups (e.g.,
phenol,
skatoles
,
indole
) may
be
detoxicated
in
liver by conjugation with
sulphate
from amino acids. Hydrocarbons are
detoxicated
by conjugation with esters
of
acetylated
cysteine
.
Enzymes such as
papain
,
urease
,
cathepsin
depend on
free
sulphahydryl
groups
for their catalytic
sites.
Nonhaem
iron enzymes such as mitochondrial NADH
dehydrogenase
, Fe-
S
proteins contain
sulphur
.
SAM acts as
a
coenzyme for
methyltransferases
Slide50Conti…SH group of glutathione acts as
donor of
reducing equivalents and enables
it to
function as
a
reducing
agent.
SH
group of
CoA
and
acyl
carrier protein (ACP) form fatty acid
thioesters
. They participate
in the
transfer
of
fatty
acyl
groups.
Adenosine 3’-P-5’
sulphate
(PAPS)
is
formed
in the liver
from ATP and
sulphate
with
the help of
ATP
sulphurase
and adenosine
5’
–
sulphate
- 3’kinase. The
sulphate
group of
“active”
sulphate
is
transferred
to other
substrates like
chondroitin
.
“Active
sulphates
” viz., PAPS, SAM,
CoA
CAP
–
are high-energy
sulphur
compounds.
Sulphur
-containing vitamins are biotin and thiamine
(coenzymes).
Protein-structure. SH
of
cysteine
forms
intrachain
and
interchain
S-S
linkages
contributing
to
secondary, tertiary and quaternary
structures.
Slide51IRON Iron is
present
in
all
organisms
and
in
all
cells.
It
is
a
transient
metal
capable
of being
present
in
Fe
2+
(ferrous) and
Fe
3+
(ferric) forms. Iron
is
essential for
the
formation
of
haemoglobin
in
RBCs, transport
of
oxygen and
oxido
-reduction reactions
of the
electron transport
chain.
Slide52SOURCESFood iron can be classified as
haem
iron
and
nonhaem
iron (iron-
porphyrin
complexes are referred
to
haem
compounds while
nonhaem
iron refers
to
substances which
have iron in the
prosthetic
group
but
no
porphyrin
).
Haeme
iron in the body is
constituted by
Hb
(85%), Mb (5%) and
heame
enzymes (10%) such as
cytochromes
,
cytochrome
oxidase
and
peroxidase
.
40% of
total food
iron is
heame
iron. It
is
obtained from
organ
meats, fish
etc.
Nonhaeme
iron
is
present
in
Fe-S proteins such as
ferredoxin
,
adrenodoxin
,
flavoproteins
,
succinate
dehydrogenase
transferrin
,
ferritin
,
haemosiderin
. The food sources
of
nonhaeme
protein are vegetables, fruits, legumes and
nuts
60%
of
total food
iron is
nonhaeme
iron.
Slide53Daily requirement:Adult man and postmenopausal women : 10
mg.
Premenopausal
women
:
15-20
mg.
Pregnant women:
30-60
mg.Serum
level
11-32umol/L.
1 g of
haemoglobin
contains
–3.4
mg
iron.
30
mg
iron loss
occurs in
menstruation.
Slide54Absorption:Mainly occurs in gastrointestinal mucosal
cells.
Vit.C
, calcium, gastric HCL, tissue
needs have
positive
influence.
Tissue saturation,
high
pH,
high
phosphates,
phytates
and oxalates
have negative
influence.
Slide55Haem iron:
Generally,
haeme
iron
is in
combination with
globin
.
Proteolytic
enzymes release
the
globin
part.
Haeme
iron enters
the
mucosal cells.
it is
transferred
via
transferrin
.
Nonhaeme
iron:
Haeme
uptake
is
enhanced
by
vitamin
C,
succinic
acid,
sugars,
sulphur
containing amino acids and increased calcium levels. Calcium
chelates
with
phytates
.
Phosphates,
phytates
, tannic acid found
in
tea and antacid preparations
inhibit
absorption.
Slide56Absorption of iron takes place largely
in the upper part of
the small intestine.
Most foods contain iron
in the
ferric
state.
The acid medium frees
the bound
iron.
Reducing substances such as vitamin C, glutathione
help
to convert ferric
iron to
ferrous
iron, this is
then absorbed.
Ferrous iron forms
chelates
with vitamin C, amino acids and
sugars.
These
chelates
remain soluble
in the
jejunum and
duodenum.
Absorption
occurs
by passive
diffusion.
The
iron
combines with
apoferritin
of
form
ferritin
.
Slide57Conservation of iron:
Body reutilizes
iron
to compensate for
the low
capability
of
iron absorption.
Iron
is
called
a
“one way” substance. Only 10%
is
absorbed
but once
absorbed, little
is
excreted.
Slide58Applied aspects:
In
pregnancy, more iron
is needed.
Milk contains
low
amounts
of
iron.
Foetus
uses maternal iron. Approximately
600
mg
is
transferred
to
the
foetus
.
Foetal
Hb
levels are
22-23
mg/dl.
Slide59Storage and transport forms of iron:
Ferritin
is
made
up of a
protein part (
apoferritin
) and
iron. 4300
iron atoms are present
in one
molecule
of
apoferritin
.
Haemosiderin
is the
form
of
brownish granules, which are large aggregates
of
ferritin
molecules. Iron content
is high.
Increased levels cause
haemosiderosis
.
Both these molecules are storage forms
of
iron.
The following are transport forms
of
iron.
Lactoferrin
is
present
in
milk, tears, cervical mucous, seminal plasma, bile,
saliva.
Slide60Transferrin binds two atoms
of Fe
3+
iron.
Transferring plays
a dual
role-
Accepts
iron
from
Intestinal
tract
Sites
of
storage
Delivers iron
to
Bone for synthesis
of
Hb
Reticulo
-endothelial system for
storage
Hb
destruction c)
Placenta
Cells containing
enzymes.
Slide61Excretion of iron:Faeces
.
Desquamation
of
skin increases
iron
loss with
sweating.
Urinary loss
is
negligible.
Menstrual loss
is
large.
In
pregnancy,
iron is
transferred
to the
foetus
.
In
lactation,
1.5
mg/day
of
iron
is
lost.
Slide62Clinical manifestations:Incr
ea
s
e
d
a
m
ounts of iron
a
re
exc
r
e
t
e
d in
hae
m
a
turia
and
haemoglobinuria
.
Iron deficiency leads
to low
plasma
bound
protein, increase
in
total
iron binding
capacity (TIBC) and decrease
in
iron and
Hb
levels.
In
women,
there is poor
intake and absorption
of
iron. There
is
loss
during
menstruation, sometimes
due to
multiple
pregnancies.
Slide63Anaemia:It
can
be
classified as
follows:
Dyshaemopoietic
. Insufficient
blood
formed
due to inadequate
intake,
absorption and utilization
of iron.
Factors required
in
adequate amounts are:
Minerals
– iron,
traces
of
cobalt and
copper.
Proteins.
Vitamin,
B
12
,
vitamin
C
and folic
acid.
Haemorrhagic
. Occurs
due to blood
loss caused by piles, ulcers, bleeding and anti-inflammatory
drugs.
Slide64Haemolytic. Occurs due to excessive intravascular
blood
destruction caused
by
red cell destruction and sensitizing
of
glucose 6-phosphate
dehydrogenase
.
Iron deficiency
anaemia
.
In its
severest form,
it is
characterized by
hypochromic
,
microcytic
red cells. defective synthesis
of
haem
- complex and iron-containing
metalloenzymes
is
responsible for fatigue and epithelial changes. It
is a
public
health
problem resulting
in
substandard performance
of
millions
of
people. Causes
include
:
Slide65Poor intake, absorption, loss of iron
during
menstruation, repeated pregnancies,
prolonged
lactation, parasitic infection. Blood
donors
may
develop
iron
deficiency.
Diseases
of bone
marrow diminish RBC production, e.g., ionizing radiation, “crowding
out” of
red cell precursors. This condition
occurs in
leukemia, multiple myeloma and Hodgkin’s
disease.
Treatment
of iron
deficiency anemia
includes
fortified food, doses
of
ferrous
sulphate
,
Fe
2+
gluconate
and rarely intramuscular
injections.
Slide66Iron excess or overload:
Idiopathic
hemochromatosis
,
a
genetically determined disease,
is
caused
by
increased
iron
absorption over
years.
In
Bantu tribes,
haemosiderosis
occurs.
Thalassemia
patients receiving repeated
blood
transfusion and
have
defective
Hb
show accumulation
of
iron.
Refractory
anaemia
occurs
due to
high-iron diet intake.
Interestingly,
patients with iron
overload
can
trigger
and alarm at
the
airport when
they go through
metal
detector.
In
treatment, iron chelating agent, viz.,
desferrioxamine
is
used.
Slide67Bronze diabetes:
It is a
disease
that
leads to
:
Increased deposits
of
haemosiderin
.
Degeneration
of
cardiac muscle, congestive
heart
failure and
hepatic
fibrosis. Pancreatic damage results
in
diabetes
mellitus.
Slide68Iron toxicity:
Re
s
ults in hepatic
f
a
ilur
e
, di
abe
t
e
s
, t
e
s
ti
cu
l
a
r
a
trophy,
a
rt
h
riti
s
,
cardiomyopathy
, peripheral neuropathy and
hyperpigmentation
.
The
following
are
the
laboratory
tests
for
assessing
patients
with
iron
disorders
:
RBC count and estimation
of
Hb
.
Determination
of
plasma
iron,
TIBC and percentage
of
transferrin
.
Ferritin
by
RIA.
Prussian
blue
stain
of
tissue.
Amount
of
iron (
g/dl)
in
tissue
biopsy.
Slide69Iodine It is an essential component
of thyroid
hormones
(T
3
and
T
4
).
Sources:
Iodized table salts, flesh and
oil of
marine fish, onion,
iodate
-enriched bread.
Daily requirement:
Adult man:
140
g;
adult
women:
100
g.
Adolescent
boy: 150
g;
adolescent girl:
g.
Pregnant woman:
125
g;
lactating woman:
150
g.
Children: 60-100
g.
Slide70Incorporation of iodine
Concentration
of iodine occurs in the
thyroid follicle actively, with
the help of a
NA
+ K
+
-
ATPase
pump.
This
iodide
(I
-
)
is then
oxidized to
iodine
(I
+
)
with
the help of
peroxidase
.
Iodination of the
tyrosine residues
of the
protein
thyroglobulin
now
occurs.
Thyroglobulin
,
a
glycoprotein, contains approximately
5000
amino acids.
115
tyrosine residues
present.
Slide71Absorption and metabolism
Free
iodine
and
inorganic
iodate
are first converted
to
iodide which are easily absorbed from gastrointestinal
tract.
Iodides
can also
be
absorbed from mucous membrane,
lungs
and
skin.
Thyroid hormones,
i.e.,
triiodothyronine
(T
3
)
and
tetraiodothyronine
(T
4
)
are iodinated
derivatives of the
amino acid,
thyronine
.
In the
thyroid gland, iodine
is
taken
up by the
active transport and oxidized
to
active
iodine.
The active
iodine is then
utilized
to iodinate
tyrosine
to
form
iodotyrosine
.
Iodotyrosine
residues are
then
coupled
to form
T
3
and
T
4
.
Slide72Functions of iodine
Iodine is
required for
the
synthesis
of
hormones,
T
3
and
T
4
.
Iodine acts
only
when it
is
synthesized and
it
carries
out the
following functions
:
Increases metabolism and oxygen consumption
of
tissues.
Increases basal metabolic
rate.
Increases conversion
of
glycogen
to
glucose leading
to
increase
in blood
sugar level.
Increases
heart
rate.
Depletes calcium and phosphorus
of bones
and increases urinary calcium excretion.
Slide73ExcretionLiver, kidneys,
muscles and
heart
deaminate
iodothyronine
to
iodothyropyruvate
. This
is then
decarboxylated
to
iodothyroacetate
.
Deiodination
occurs in
peripheral
tissues.
Detoxication
is
carried
out by
methylation
or conjugation with
glucuronic
and
sulphuric
acids excreted
in bile
and
urine.
Slide74Iodine deficiency It
leads
to
still
births,
abortions,
congenital
heart
anomalies,
endemic cretinism, mental retardation and neurological defects.
Treatment
of iodine
deficiency before pregnancy prevents disorders
in
children.
Slide75Applied aspects
Goitre
is
the
enlargement
of
thyroid
gland.
There
are
normal,
hypo
and
hyperthyroid
states. Simple
goitre
results
in
decreased
thyroxine
production.
It
occurs due to
defect
in the
steps for
production of
thyroid hormones.
Simple endemic
goitre
occurs due
to
inadequate
supply
of iodine,
hypothyroidism and
myxoedema
in
adults.
Myxoedema
is due to
hypothyrodisim
in
adults. Basal metabolic rate and
body
temperature are lowered and memory
is poor in this
disease.
Cretinism
is due to
incomplete development or congenital absence
of thyroid
gland. It
is
evident
in
children. Children are dwarfed, mentally retarded and
have
protruding
tongue
and
pot
bellies.
Slide76HyperthyroidismExpoththalmus, enlarged and hyperactive
thyroid.
Grave’s disease results from increased
production of thyroid
stimulating
immunoglobin
(TSI)
that
activates TSH receptor,
LATS
(long-acting thyroid stimulating
factor).
Hashimoto’s disease. Occurs
due to
destruction
of thyroid
tissues, e
ff
e
c
ts of
an
tithyroid
an
tibio
t
i
c
s
, over
p
roduction of
T
S
H
and hyperthyroidism.
Slide77Application Antithyroid substances such as cabbages, turnip,
soyabean
cause simple
goitre
.
Goitrogenic
substances contain L-5-viny-2-
thiooxazolidone
.
Radioiodine studies. radioiodine uptake studies are undertaken
to
determine
the
overall activity
of the
gland, particularly
in
hyperthyroidism. Trace doses
of
I
125
or
I
131
are administered orally and percentage
of iodine
taken
up
by thyroid gland
is
measured
by
counting
-rays at standard time
intervals.
In
patients with Grave’s disease, thyroid uptake
is
measured before and after an 8-day course
of
iodinated
T
3
administration. No
decline in
uptake
is
observed.
Slide78zincThe total content of zinc in
the
body
is
about
2.3 g of
which
80-110
mg/dl
is
found
in the
plasma. High concentrations
of
zinc are found
in
choroid
of
eyes, prostate, kidneys,
liver
and
muscles.
Daily requirement:
Pregnancy: 5mg.
Lactation: 10mg. Serum level
11-24umol/L.
Sources:
Meat,
liver,
seafood, eggs, vegetable and whole gram (less available
due to
phytates
).
Slide79Absorption & ExcretionAbsorption:
Zinc
absorption
is
proportional
to
the
protein
(
metallothionein
)
level
in
intestinal
muscosal
cells.
metallothionenin
serves as
a
carrier for zinc also.
This absorption
is
interfered by copper, phosphate,
phytate
and calcium.
Excretion:
Occurs through
faeces
and
urine
(in traces) and some amount
in
sweat.
Slide80FunctionsOver three hundred zinc-containing enzymes have been
identified, e.g., LD, carbonic
anyhydrase
, alkaline
phosphatase
,
carboxypeptidase
.
Zinc
is
also
present
in
cytosolic
superoxide
dismutase.
It
also
contains copper. The mitochondrial superoxide dismutase contains
manganese.
It is involved in the
synthesis
of
DNA and
proteins.
Zinc
forms an essential and integral part
of
insulin during storage
in
-
islet cells. Once released,
it need not bind to
zinc. Long-acting insulin preparations are
in the form of
protamine
-zinc-insulin.
Zinc
stimulates vitamin
A
release from liver and
blood.
Zinc
protein, “
gustin
”
is
present
in
saliva and it plays an important role
in the
sense
of
taste.
Zinc is involved in
wound
healing.
Slide81Decreased levels are seen in acute and chronic
infection, myocardial infarction, malignancies, patients with alcoholism
liver
disease and
malabsorption
.
Acrodermatitis
enterohepatica
is a
rare inherited disorder
due to a
defect
in
zinc
absorption.
Inherited zinc deficiency
is
associated with dermatologic, ophthalmologic and intestine disturbances,
hypogonadism
, growth
retaradation
and decreased size
of
male
gonads.
Zinc
supplements can cure
the
deficiency.
Zinc is
relatively nontoxic.
Inhalation
of
zinc
oxide
(
ZnO
) leads
to
acute illness and
headache.
Poisoning
due to
ingestion from containers causes nausea and
fever.
Slide82Copper The normal concentration of copper
in
serum
is
90mg/dl. Copper
is
transported
in the bound form
as
ceruloplasmin
.
It is
stored
in liver,
muscles and
bones of the
body. Copper
is
present
in a
number
of
metalloenzymes
.
Daily requirement:
Adults
:
2mg.Serum level
11-20umol/L
Sources:
Nuts, dried fruits, pulses, meats, fruits’ oysters and
fish.
Slide83FunctionsCopper is
present
in
oxidases
. Eleven such enzymes are identified, e.g.,
cytochrome
oxidases
, superoxide
dismutase.
Required for biosynthesis
of
haemoglobin
. Utilization
of iron
for
haemoglobin
synthesis
is
enhanced
by
ceruloplasmin
which
is a blue
copper protein complex
that
catalyzes
Fe
2+
Fe
3+
.
Deficiency
of
copper leads
to
microcytic
anaemia
.
Required for
bone
formation and maintenance
of
myelin.
Plays role
in lipid
and amino acid
metabolism.
Copper-containing proteins
are:
Ceruloplasmin
,
Erythrocuprin
,
Cytochrome
oxidase
, Monoamine
oxidase
, Melanin.
Slide84Absorption & Excretion Absorption:
Cu
2+
is
insoluble at intestinal
pH.
It gets bound to a
protein (
metallothionein
) and
gets
absorbed from
intestional
mucosal cells and
stomach.
Leucine
enhances absorption
of
copper.
Once absorbed, copper
gets bound to
albumin.
Excretion:
It is
excreted
in
bile,
urine
and
sweat.
Slide85Clinical manifestationsWilson’s disease or hepatocellular
degeneration:
Caused by
a
defect
in
transporting
the
absorbed copper across
the
serosal
membrane
of
intestinal mucosal
cells.
Pathological changes
include
demyelination
, degeneration and
cavitation
of the
basal
ganglion in the
brain and cirrhosis
of the
liver. Personality changes, tremors and
hepatic
failure
occur.
Low
plasma and
high
urinary levels,
high
deposition
of
copper and
low
ceruloplasmin
.
Abnormal muscular movements, diabetes mellitus, renal tubular damage, visible brown
rings
(
Kayser
-Fleischer ring) at
the
margin
of
cornea, dementia and
jaundice.
The patient dies
of hepatic
failure.
Copper-chelating agents are used
to
treat
the
disease, e.g.,
pencillamine
.
Slide86Conti….Menke’s kinky hair
syndrome:
It is a genetic
disorder.
Occurs
due to
deficiency
in
copper absorption.
Symptoms are
kinky hair, pale
skin,
depigmented
hair, low
body
temperature and demineralization
of the bone.
Mental retardation occurs.
Slide87Toxicity Toxicity of copper
results
in
nausea, vomiting,
headache,
dizziness, hypertension and
death.
Copper toxicity also
hepatic
cirrhosis, tremor, mental deterioration,
Kayser
-Fleischer rings,
heaemolytic
anaemia
and renal dysfunction (
Fanconi
-like
syndrome).
Slide88Molybdenum Though a deficiency of
molybdenum
has not been
observed
in
man,
it is
an essential constituent
of
many
enzymes.
Sources:
Milk, beans, breads, cereals, liver and
kidney.
Daily requirement:
Adults: 0.15-0.5
mg.
Absorption:
Readily absorbed. Excreted
in
urine and
bile.
Slide89Functions & ToxicityFunctions:
Involved in
uric acid
metabolism.
Involved in
enzymatic
action.
Occurs
in
several
metalloflavoproteins
containing
nonhaeme
iron, e.g.,
aldhehyde
dehydrogenase
,
xanthine
oxidase
.
Molybdenum-containing enzymes participate
in
electron
transfer.
Traces
of
molybdenum
help in
utilization
of
copper while larger amount diminish
the
same.
Toxicity:
Increased molybdenum
may
produce
microcytic
anaemia
, and
low
levels
of
tissue
copper.
Slide90Fluorine 10-20
mg
of
fluorine
in
its
ionized
form
is
present
in
the
blood.
Although
not
strictly essential, fluoride enhances well
being.
Fluoride
is
found
in the bones
and
teeth.
Sources:
Drinking water, tea, salmon and
sardine.
Requirement:
1-2ppm
(since fluorine
is
absorbed
through
water it
is
expressed as
ppm
).
Absorption
and
excretion:
Easily absorbed from small
intestine.
More
than half of the
ingested fluoride
is
excreted
through urine
and
the
rest
is
deposited
in
bones, where
there is
accumulation with
age.
Slide91FunctionsTooth development and dental health.
Fluorine
is
required in traces for development
of
teeth.
Helps
in
prevention
of
dental
caries.
Large amounts causes
fluorosis
involving
mottling
of the
enamel.
In
these conditions, enamel
is
stratified and
it has
dull white patches. Tooth shows brown stains and
pits.
Bone
development
Promotes
bone
development.
Increases calcium and phosphate retention and prevents old-age osteoporosis.
Increased uptake enhances
osteoblastic
activity, calcium deposition and density
of
bones.
Fluoride
is
an
inhibitor of
enolase
,
blocking this
enzyme
inhibits
glycolysis
.
Slide92SeleniumAbout 5-15mg of selenium
is
found
in
the
body.
Selenium serves to protect cells against
destruction.
Sources:
Present
in liver,
kidney, seafood, meats and
grains.
Daily requirement:
Adult man/woman:
0.2
mg.
Infants and children:
0.02-0.1
mg.
Slide93functionsIt is an integral part of
enzymes, glutathione
peroxidase
, which
has the
following functions
:
Protects vital cell components, such as cell membranes from
dangers of
hydrogen peroxide and other
peroxides.
Supplements
the
action
of
superoxide dismutase
in
protecting
cells against superoxide
(O
2
)
and
other
free
radicals.
Selenium spares vitamin
E
requirement
in
three ways
:
Normal pancreatic function and thereby digestion and absorption
of lipids
including vitamin
E.
Component
of
glutathione
peroxidase
.
Aids retention
of
vitamin
E in
blood.
Slide94Toxicity & Deficiency symptomsToxicity:Humans
living in
selenium-rich soil zones are prone
to its
toxicity.
Excess
of
selenium
in
cattle causes alkali disease, liver necrosis and muscular
dystrophy.
Deficiency
symptoms:
Cardiac dilation,
abnormal
ECG, congestive
heart
failure.
An endemic disease, seen
in
children
due to low
selenium content
is
called
Keshan
disease.
Slide95CobaltCobalt is a constituent
of
vitamin
B
12
.
The total
body
content
of
cobalt
is 1.1
mg.
It
is
readily absorbed from
the
small
intestine.
Daily requirement:
Though
the
average intake
of
cobalt
is 0.3
mg
per day, the
daily requirement
has not
yet
been
established.
Sources
Figs, cabbage, lettuce, spinach and animal
products
such as
liver
and
kidneys.
Slide96FunctionsIt is a component of
vitamin
B
12
which contains 4%
of the
element.
It
is
necessary for
Hb
formation.
It plays
an analogous
role to
copper
in
ferroxidase
and
iron in
Hb
.
Cobalt may substitute for manganese as an activator
of
enzymes.
It is a
specific activator
of the
enzyme,
glycylglycine
dipeptidase
.
It
also activates enzymes such as
phosphotransferases
and
lyases
.
It
causes an increase
in the
number
of
RBCs.
Cobalt
induces
polycythemia
by increasing formation
or inhibiting
destruction
of
erythropoietin,
the
stimulating hormone secreted by
kidney.
This leads
to the
development
of
macrocytic
anaemia
.
Slide97Excretion & ToxicityExcretion:
0.26
mg/day
is
excreted
in
urine.
Toxicity:
Cobalt
it
added during processing
of beer
as
a
foam stabilizer. Congestive
heart
failure from
cardiomyopathy
has been
reported
in individuals
who
have
consumed
large quantities
of
beer.
Slide98ChromiumChromium exists
in
two
forms,
viz
,
the
trivalent
and
the
hexavalent.The
trivalent form
is
biologically
active.
Sources:
Yeast
, milk, meat and
cereals.
Daily requirement:
-
Adults
:
0.05-0.15mg
Absorption:
It is
absorbed by
the
small
intestine.
Excretion:
Traces are excreted in
urine.
Slide99Functions & ToxicityFunctions:
Acts as cofactor for
insulin.
Helps
to
increase
not only
glucose utilization but also transport
of
amino
acids.
Important
in
lipoprotein metabolism. Small amounts play an important
role in
carboydrate
and
lipid
metabolism apparently as
a
cofactor for insulin.
Further classifications
of the
precise biochemical functions are
needed.
Toxicity:
Excess
of
chromium
(Cr
3+
) is
toxic.
The
hexavalent
element
is
more toxic. Occupational exposure
to
chromium dust causes
lung
cancer. Appreciable amount
of
chromium are contributed by cooking
in
stainless steel
containers.
Slide100ManganeseThe total body content of manganese
is
about
30
mg.
Daily requirement
:
Adults: 2-5
mg.
Children:
0.5-2.0
mg.
Sources:
Cereals, vegetables,
liver,
kidney, muscle and
tea.
Slide101FunctionsActs as a cofactor for enzymes such as
arginase
,
isocitrate
dehydrogenase
,
leucine
aminopeptidase
. Manganese-containing enzymes are
hydrolases
,
kinases
,
decarboxylases
and
transferases
.
It is a
cofactor for mitochondrial superoxide
dismutase.
Role
in
animal
reproduction. Deficiency causes sterility
in
animals and disturbance
in
citric acid
cycle.
P
rot
eog
l
y
ca
n
s
y
nthe
s
i
s
.
P
r
o
m
ot
e
s
s
y
nthe
s
is
an
d depo
s
ition of
prot
eog
l
y
ca
n
in
m
an
y ti
ss
ues including bones due to
glycosyl
transferase
activity.
Po
rp
h
y
r
in
s
y
nthe
s
i
s
.
So
m
e
porp
h
y
r
ins
of
e
rythro
c
y
t
e
s
con
t
a
in
manganese.
Bone growth and cholesterol synthesis require
manganese.
Slide102Absorption, transport and excretion
Absorbed from
gut.
Miners absorb manganese dust through
lungs.
Transported
in
combination with
-globulin called
transmanganin
.
Stored
in
liver.
Little
is
excreted
in urine.
Excreted mainly through
bile
and
faeces
.
Slide103Clinical manifestationsDeficiency results in the following symptoms
:
Defective growth
in
mammals and
birds.
Respiratory
dysfunction.
Disturbance
in
lipid
metabolism.
Hypoglycemia, poor
bone
growth and lactation
problems.
Slide104ConclusionMinerals are essential for good health. Evidence
of
mineral malnutrition are
various
minor and serious
health
conditions such as premature aging and degenerative diseases
like
osteoporosis etc. In
many
cases these could
be
prevented with proper mineral supplementation .Thus even
though
nutrition
is not
recognized as
a
risk factor for periodontal diseases, nutrition
is
acknowledged to
have a
significant impact
on
optimal functioning
of
the immune response. Dental professionals
need to
routinely assess nutritional status and
provide
basic nutrition counseling
to their
patients ensure optimal functioning
of the
immune system
in
combating infection and
to
promote optimal periodontal
health.
Slide105