calcium-phosphorus metabolism final printer...
TRANSCRIPT
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Calcium-Phosphorus Metabolism
Kiril Terziyski, MD, PhDPathophysiology Dept.
Medical University of Plovdiv
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A tale of …
CalciumPhosphorus
Magnesium
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Calcium functions
Excitability
Muscle contraction
Second messengerExocytosis
Teeth
Bones
99.9%
Coagulation
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Phosphorus functions
Bones
99.9%
Acid-base balance
DNA
ATP
Teeth
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Up and Down
Rickets
Ca – 2.12–2.62 mmol.L-1
Ca2+ – 1.06–1.31 mmol.L-1
Ionized calcium–50%Protein-bound calcium–40%Complex-bound calcium–10%
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Trinity(ies)
• Three ions– Ca, P, Mg
• Three organs– Bones, Kidneys, Intestines
• Three hormones– PTH, Calcitonin, Vitamin D3
• Three types of cells– Osteoblasts, Osteoclasts, Osteocytes
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Three organs
• Intestines(20-75% absorption)• Kidneys(re-absorption)• Bones(temporary bank; ±500 mg)
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The three tenors and the orchestra
• PTH• Vitamin D3• Calcitonin
¢ Estrogens¢ Androgens¢ Corticosteroids¢ T3/T4¢ STH¢ Serotonin¢ pH, Albumin, FFA
Agonist (PTH), Antagonist (Calcitonin) and … why do we need a third one?
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In Blood We Trust
We don’t care for the bones! The brain and the muscles are more important!
2.12 2.62
PTH Calcitonin
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(Bad) to the bone Pleiotropic functions
HaemmopoesisAnti-cancer
Anti-autoimmune
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Qui vitam dat
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D(3)evolution
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The right to choose• Rickets• Osteoporosis• Psoriasis• Depression• Immunity
¢ Melanoma¢ Cataract¢ Skin aging¢ Sunstroke¢ Dehydration
OR
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“Can these bones live?”
• RANKL – Receptor Activator of NFkB Ligand
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Ca2+uses of hypoCa2+lcemia• Hypoparathyroidism• Vit D defficiency/ insufficiency• Renal/ Hepatal diseases• Pseudohypoparathyroidism• Hypomagnesiemia or hypermagnesiemia• Hungry bone syndrome• Phosphate infusion• Rapid citrated blood transfusion• Medications
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Felis Ca2+tus
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ChimpanzeesCauses of Hypercalcemia• Calcium supplementation• Hyperparathyroidism• Iatrogenic, immobilization• Multiple myeloma• Parathyroid hyperplasia/ adenoma• Alcohol• Neoplasm (breast, lung cancer)• Zollinger-Ellison Sy (gastrinomas)• Excessive Vit D• Excessive Vit A• Sarcoidosis
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HyperCa2+lcemia signsRenal• Nephrolithiasis• Interstitial nephritisGastorintestinal• Constipation• Anorexia• Nausea• Peptic ulcer• PancreatitisEctopic calcification• Pruritus• Cerathopathy
Neuromuscular¢ Muscle weakness¢ HyporeflexiaPsychiatric¢ Lethargy¢ Somnolence¢ Depression¢ PsychosisCardiovascular¢ Shortened QT interval¢ Depressed T waves¢ Heart block
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Primary vs Secondary
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Let Mg2+ enter the game
• Malnutrition Sts• Malabsorption Sts• Renal failure• Alcoholism• Diuretics• Tetany• Muscle excitability
and tremors
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Too Much
• Depression• Hyporeflexia• Muscle weakness• Nausea• Vomiting• Hypotension• Bradycardia• Respiratory
depression
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The Gray Cardinal
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The Gray Cardinal
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Osteoporosis vs Osteomalacia
¢ Decreased mineralization¢ Normal bone mass
• Normal mineralization• Decreased bone mass
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X-ray crossfire
T-score
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Be Bone Greedy!
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Types of Osteoporosis
• Senile• Drug-induced• Immobilization-related• Haemmatologic• Congenital• Endocrine
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Senile osteoporosis pathogenesis
• Menopause (the orchestra)• Decreased sun exposure (Vit D)• Decreased physical activity• Decreased sensitivity to Vit D• Impaired renal function and calcium loss• Poor diet• Drugs
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Access Osteoporosis
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Access denied
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The Fall of Life• Osteoporosis• Locomotor instability• Impaired vision• Decreased strength• Ortostatism• Medications
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