Mr. sankappa gulaganji - PowerPoint Presentation

Slide1

Mr. sankappa gulaganjiAsst professorBldea’s shri b m patil institute of nursing sciences, vijayapur

Minerals

Slide2

Introduction 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:

Slide3

Groups 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

Slide4

Conti…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

Slide5

Conti….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

Slide6

SodiumSodium 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

Slide7

Conti…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.

Slide8

Functions 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.

Slide9

Excretion 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.

Slide10

HypernatraemiaIt 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.

Slide11

HyponatraemiaIt occurs in the following conditions :

Gastroenteritis with

diarrhoea

and

vomiting

Severe

burns

Small

gut

obstruction

Addison’s disease

Use

of

mercurial

diuretics.

Slide12

PotassiumPotassium 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

Slide13

AbsorptionPotassium 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.

Slide14

ExcretionIt 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.

Slide15

Functions 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.

Slide16

Conti…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.

Slide17

HyperkalemiaCauses-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.

Slide18

Conti…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.

Slide19

Hypokalaemia 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

Slide20

Conti…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

Slide21

Conti…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.

Slide22

Calcium (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

Slide23

Daily 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)

Slide24

Factors 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

Slide25

Functions 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

.

Slide26

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

.

Slide27

Conti…Activation of

Enzymes

:

Calmodulin

–

Ca binding

regulatory protein.

Binds

with

4

Ca ions

and leads

to activation

of

enzymes.

Slide28

Normal 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

Slide29

Slide30

HypercalcaemiaDeficiency 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

Slide31

HypocalcaemiaHypocalcaemia:It is

observed

in:

Tetany

Hypoparathyroidism

Fanconi’s

syndrome (disorder

of

tubular

reabsorption

)

Acute

pancreatitis

Vitamin

D

deficiency

Chronic renal failure

Slide32

Applied 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

.

Slide33

ChlorineChlorine 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

Slide34

Absorption, 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.

Slide35

FunctionsFunctions:

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.

Slide36

Hyperchloraemia & 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.

Slide37

PHOSPHORUSTotal 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.

Slide38

Functions: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.

Slide39

Regulation 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.

Slide40

Clinical manifestationsDeficiency of phosphorus results

in

osteomalacia

, renal rickets and cardiac

arrhythmia.

Hyperphosphataemia

:

It is

observed in:

Diabetes mellitus,

starvation

Renal

insufficiency

Hypothyroidism

Hypervitaminosis

D

Slide41

Hypophosphataemia:It is

seen

in:

Rickets

Fanconi’s

syndrome

Intake

of

drugs such as

antacids

Slide42

Applied 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.

Slide43

MAGNESIUMMagnesium 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.

Slide44

Absorption: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.

Slide45

Functions: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).

Slide46

Clinical 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.

Slide47

SULPHURProteins 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.

Slide48

Absorption: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

.

Slide49

Excretion & 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

Slide50

Conti…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.

Slide51

IRON 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.

Slide52

SOURCESFood 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.

Slide53

Daily 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.

Slide54

Absorption: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.

Slide55

Haem 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.

Slide56

Absorption 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

.

Slide57

Conservation 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.

Slide58

Applied 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.

Slide59

Storage 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.

Slide60

Transferrin 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.

Slide61

Excretion 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.

Slide62

Clinical 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.

Slide63

Anaemia: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.

Slide64

Haemolytic. 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

:

Slide65

Poor 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.

Slide66

Iron 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.

Slide67

Bronze 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.

Slide68

Iron 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.

Slide69

Iodine 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.

Slide70

Incorporation 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.

Slide71

Absorption 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

.

Slide72

Functions 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.

Slide73

ExcretionLiver, 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.

Slide74

Iodine 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.

Slide75

Applied 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.

Slide76

HyperthyroidismExpoththalmus, 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.

Slide77

Application 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.

Slide78

zincThe 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

).

Slide79

Absorption & 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.

Slide80

FunctionsOver 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.

Slide81

Decreased 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.

Slide82

Copper 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.

Slide83

FunctionsCopper 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.

Slide84

Absorption & 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.

Slide85

Clinical 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

.

Slide86

Conti….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.

Slide87

Toxicity 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).

Slide88

Molybdenum 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.

Slide89

Functions & 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.

Slide90

Fluorine 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.

Slide91

FunctionsTooth 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

.

Slide92

SeleniumAbout 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.

Slide93

functionsIt 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.

Slide94

Toxicity & 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.

Slide95

CobaltCobalt 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.

Slide96

FunctionsIt 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

.

Slide97

Excretion & 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.

Slide98

ChromiumChromium 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.

Slide99

Functions & 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.

Slide100

ManganeseThe 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.

Slide101

FunctionsActs 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.

Slide102

Absorption, 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

.

Slide103

Clinical 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.

Slide104

ConclusionMinerals 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