Calcium and phosphate metabolism is tightly regulated in the body. Calcium is mainly stored in bones while phosphate is found intracellularly and extracellularly. Vitamin D, parathyroid hormone, and calcitonin control calcium and phosphate levels by impacting absorption in the gut and kidneys. An imbalance can result in hypercalcemia with symptoms like nausea and fatigue, or hypocalcemia which can cause tetany.
This is a PPT of calcium and phosphate metabolism. Clinical correlation are not included. Hope it is useful to you all. Please Like and Share it with your friends
This seminar includes sources,daily requirement,metabolism i.e absorption and excretion of calcium and phosphate and various factors associated due to increase or decrease in the levels of calcium and phosphate within the body
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
This is a PPT of calcium and phosphate metabolism. Clinical correlation are not included. Hope it is useful to you all. Please Like and Share it with your friends
This seminar includes sources,daily requirement,metabolism i.e absorption and excretion of calcium and phosphate and various factors associated due to increase or decrease in the levels of calcium and phosphate within the body
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
This presentation deals with the physiological aspect of Calcium and phosphate metabolism, it's relationship with the various types of rickets and possible remedies
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
This presentation deals with the physiological aspect of Calcium and phosphate metabolism, it's relationship with the various types of rickets and possible remedies
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Indian Dental Academy: will be one of the most relevant and exciting
training center with best faculty and flexible training programs
for dental professionals who wish to advance in their dental
practice,Offers certified courses in Dental
implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic
Dentistry, Periodontics and General Dentistry.
This presentation provides knowledge about Calcium, its role in human body, homeostasis, factors affecting calcium absorption, drugs affecting calcium regulation, various endogeneous & exogeneous substances, recent research. This ia an assignment in the subject Advanced Pharmacology -II, 1st year M.Pharm, 2nd semester.
This slide explain the importance of calcium its functions and its availability in body and the factors influencing and inhibiting the calcium availability.
Minerals are inorganic compounds that are required for the body as one of the nutrients.
The inorganic elements (minerals) constitute only small potion of body weight.
Human body needs number of minerals for its functioning.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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3. DEFINITION OF METABOLISMDEFINITION OF METABOLISM
It is defined as the chemical and physical
process in an organism by which protoplasm
is produced , sustained , and then
decomposed to make energy available.
Metabolism: is the biochemical
modification of chemical compounds in living
organisms and cells that includes the
biosynthesis of complex organic molecules
(anabolism) and their breakdown
(catabolism).
4. INTRODUCTIONINTRODUCTION
The minerals in foods do not contribute directly
to energy needs but are important as body
regulators and as essential constituents in many
vital substances within the body.
About 25 elements have been found to be
essential, since a deficiency produces specific
deficiency symptoms.
5. Principal Minerals include - Calcium, Phosphorous,
Magnesium, Sodium, Potassium and Sulphur.
Calcium and phosphorous individually have their
own functions and together they are required for
the formation of hydroxyapatite and
physical strength of the skeletal tissue.
8. CALCIUM PHOSPHATE RATIOCALCIUM PHOSPHATE RATIO
Calcium : Phosphate ratio normally is 2:1.
Increase in plasma calcium levels causes
corresponding decrease in absorption of
phosphate.
This ratio is always constant.
The serum level of calcium is closely regulated
with normal total calcium of 9-10.5 mg/dL and
normal ionized calcium of 4.5-5.6 mg/dL.
Serum Phosphate levels
Children - 4 to 7 mg/dL
Adults - 3 to 4.5 mg/dL
10. Dietary SourcesDietary Sources
Calcium:
- milk and milk
products
- eggs
- fish
- vegetables
- fruits (oranges)
- fortified bread
- nuts
- hard water
Phosphates:
- same as calcium
- present in high
amount
in cereals and pulses
- absent in hard water
11. Functions of CalciumFunctions of Calcium
Muscle contraction
Formation of bone and teeth
Coagulation of blood
Nerve transmission:Integrity of cell
membrane by maintaining the resting
membrane potential of the cells
Release of certain hormones
12. Major structural element in the
vertebrate skeleton (bones and teeth) in
the form of calcium phosphate
(Ca10(PO4)6(OH)2 known as
hydroxyapatatite
Key component in the maintenance of
the cell structure
Membrane rigidity, permeability and
viscosity are partly dependent on local
calcium concentrations
13.
14. Functions of PhosphatesFunctions of Phosphates
Formation of bones.
Like calcium, important component of teeth.
Important constituent of cells.
Forms energy rich bonds in ATP.
Forms co-enzymes.
Regulates blood and urinary pH.
Forms organic molecules like DNA & RNA.
15. Absorption of CalciumAbsorption of Calcium
Calcium is taken through dietary sources as calcium
phosphate, carbonate, tartarate and oxalate. It is
absorbed from the gastrointestinal tract in to blood and
distributed to various parts of the body.
Two mechanisms have been proposed for the
absorption
of calcium by gut mucosa:
Simple Diffusion.
An active transport process, involving energy
and calcium pump.
16. While passing through the kidney, large quantity of
calcium is filtered in the glomerulus. From the
filtrate, 98 to 99% of calcium is reabsorbed in the
renal tubules in to blood and only small quantity is
excreted through urine. In the bone, the calcium
may be deposited or resorbed depending upon the
level of calcium in the plasma.
17. Factors controlling absorptionFactors controlling absorption
Factors are classified into
1. Those acting on the mucosal cells
2. Those affecting the availability of
calcium and phosphates in the gut.
18. Factors acting on the mucosal cellsFactors acting on the mucosal cells
Vitamin D
Pregnancy and growth
PTH
19. VITAMIN-D
Calcitriol (1,25-DHCC) is the biologically
active form of vit-d
It regulates plasma levels of Ca and P
Calcitrial acts at 3 different levels intestine,kidney,
bones
Action on Intestines:
It increases the intestinal absorption of ca&p iin the
intestinal cells calcitriol binds with a cytosolic receptor
to form a calcitriol-receptor commplex
This complex then approaches the nucleus and
interacts with a specific dna leading to synthesis of
specific ca binding protein
This protein increases the ca uptake by intestine
20. Action on bone:
In the osteoblasts of bone calcitriol
stimulates ca uptake for deposition as
capo4
Action on kidney:
It is involved in minimizing the excretion of
ca&p through kidney by decreasing their
excretion and enhancing reabsorption
21. • During later stages of pregnancy, greater amount of calcium
absorption is seen.
• 50% of this calcium is used for the development of fetal
skeleton and the rest is stored in the bones to act as a reserve
for lactation.
• This is due to the increased level of placental lactogen and
estrogen which stimulates increased hydroxylation of vitamin
D.
• In growth there is a increased level of growth hormone.
GH acts by increasing calcium absorption. It also
increases the renal excretion of calcium and phosphates.
Pregnancy and growth:
22. • Parathyroid hormone is one of the main hormones
controlling Ca+2
absorption.
• It mainly acts by controlling the formation of
1,25 DHCC, which is active form of Vit. D, which is
responsible for, increased Ca+2
absorption.
Parathyroid Hormone:
23. Factors affecting availability ofFactors affecting availability of
Calcium and Phosphates in gut.Calcium and Phosphates in gut.
pH of the intestine
Amount of dietary calcium and phosphates
Phytic acid and Phytates
Oxalates
Fats
Proteins and amino acids
Carbohydrates
Bile salts
24. pH of intestine:
• Acidic pH in the upper intestine (deodenum) increases calcium
absorption by keeping calcium salts in a soluble state.
• In lower intestine since pH is more alkaline, calcium salts
undergoes precipitation
25. Amount of dietary calcium and
phosphates:
• Increased level of calcium and phosphate in diet increases
their absorption however up to a certain limit.
• This is because the active process of their absorption can
bear with certain amounts of load beyond which the excess
would pass out into faeces
26. Phytic acid and phytates:
• They are present in oatmeal, meat and cereals and are
considered anti-calcifying factors as they combine with calcium
in the diet thus forming insoluble salts of calcium
Oxalates:
• They are present in spinach and rhubarb leaves. They form
oxalate precipitates with calcium present in the diet thus
decreasing their availability.
Fats:
• They combines with calcium and form insoluble calcium ,
thus decreasing calcium absorption.
27. Bile salts:
• They increases calcium absorption by promoting metabolism
of lipids.
•
Protein and aminoacids:
• High protein diet increases calcium absorption as protein
forms soluble complexes with calcium and keeps calcium in a
form that is easily absorbable.
Carbohydrates:
• Certain carbohydrates like lactose promotes calcium
absorption by creating the acidity in the gut as they favours
the growth of acid producing bacteria.
28. Concept of Calcium BalanceConcept of Calcium Balance
Defined as the net gain or loss of calcium by the
body over a specified period of time
Calculated by deducting calcium in faeces and
urine from the calcium taken in diet.
Positive calcium balance in growing children
Negative calcium balance in aging adults.
29. Hormonal Control of Calcium &Hormonal Control of Calcium &
Phosphate metabolismPhosphate metabolism
Three hormones regulate calcium and phosphate
metabolism.
Vitamin D
PTH
Calcitonin
30. Vitamin DVitamin D
Cholecalciferol / D3
Ergocalciferol / D2
Can be called as hormone as it is produced in the skin when
exposed to sunlight.
Vitamin D has very little intrinsic biological activity.
Vitamin D itself is not a active substance, instead it must be first
converted through a succession of reaction in the liver and the
kidneys to the final active product 1, 25 di hydroxycholecalciferol,
32. Dietary sourcesDietary sources
Cod liver oil
Fish- Salmon
Egg, liver
• Mean action of vitamin D is to increase the plasma level of
calcium.
• Increases intestinal Ca&P absorption.
Increases renal reabsorption of Calcium and
phosphate.
33. Parathyroid HormoneParathyroid Hormone
(PTH)(PTH)
Secreted by parathyroid gland
Glands are four in number
Present posterior to the thyroid gland
Formed from third and fourth branchial pouches
Combined weight of 130mg with each gland weighing
between 30-50mg.
Histologically – two types of cells
Chief cells (forming PTH)
Oxyphilic cells (replaces the chief cells
stores hormone)
34.
35. Parathyroid HormoneParathyroid Hormone
Single chain polypeptide
Molecular weight 9000
Consist of 84 amino acids
Plasma half life – 20-30 minutes
Plasma concentration – 10-50ug/ml
Measured by immunoassay .
36. Actions of PTHActions of PTH
The main function is to increase the level of
Ca in plasma within the critical range of 9
to11 mg.
Parathormone inhibits renal phosphate
reabsorption in the proximal tubule and
therefore increases phosphate excretion
Parathormone increases renal Calcium
reabsorption in the distal tubule, which also
increases the serum calcium.
Net effect of PTH serum calcium↑
↓ serum phosphate
37. Stimulation for PTH secretionStimulation for PTH secretion
The stimulatory effect for PTH secretion
is low level of calcium in plasma.
Maximum secretion occurs when plasma
calcium level falls below 7mg/dl.
When plasma calcium level increases to
11mg/dl there is decreased secretion of
PTH
38. CALCITONINCALCITONIN
Minor regulator of calcium & phosphate
metabolism
Secreted by parafollicular cells or C-cells of
thyroid gland.
Also called as thyrocalcitonin.
Single chain polypeptide
Molecular weight 3400
Plasma concentration – 10-20ug/ml
39. Action of CalcitoninAction of Calcitonin
Net effect of calcitonin decreases Serum Ca
Target site
◦ Bone (osteoclasts)
decreased ability of osteoclasts to resorb bone
Osteoclasts cells
◦ Lose their ruffled borders
◦ Undergo cytoskeletal rearrangement
◦ Decreased mobility
◦ Detach from bone
40. Calcitonin is a Physiological Antagonist to
PTH with respect to Calcium.
With respect to Phosphate it has the same
effect as PTH i.e. ↓ Plasma Phosphate level
41. OTHER HORMONES on CALCIUMOTHER HORMONES on CALCIUM
METABOLISMMETABOLISM
GROWTH HORMONE
INSULIN
TESTOSTERONE & OTHER HORMONES
LACTOGEN & PROLACTIN
STEROIDS
THYROID HORMONES
42. Increases the intestinal absorption of calcium and increases its
excretion from urine
Stimulates production of insulin like growth factor in bone which
stimulates protein synthesis in bone
Stimulates stomatomedian C which acts on cartilage to increase
the length of bones
GROWTH HORMONE
43. TESTOSTERONE
Testosterone causes differential growth of
cartilage resulting to differential bone
development
Acts on cartilage & increase the bone growth.
INSULIN
• It is an anabolic hormone which favors bone formation
44. Thyroid HormoneThyroid Hormone
In infants stimulation of bone growth
In adults
increased bone metabolism increased
calcium mobilization
45. GlucocorticoidsGlucocorticoids
Anti vitamin D action, decrease
absorption of calcium in intestine
Inhibit protein synthesis and so decrease
bone formation
Inhibit new osteoclast formation &
decrease the activity of old osteoclasts.
46. Excretion of Calcium and PhosphorousExcretion of Calcium and Phosphorous
Calcium is excreted in the urine, bile, and digestive
secretions.
The renal threshold for serum ca is 10 mg/dl.
70-90% of the calcium eliminated from the
body is excreted in the feces.
The daily loss of calcium in sweat is about 15 mg.
47. Daily turnover rates of Ca in an adult are as follows:
Intake 1000mg.
Intestinal absorption 350mg
Secretion in GI juice 250mg
Net absorption over secretion 100mg
Loss in the faeces 200mg
Excretion in the urine 80-100mg
48. PhosphorousPhosphorous ExcretionExcretion
Phosphorous is excreted primarily through the urine.
Almost 2/3rd
of total phosphorous that is excreted is
found in the urine as phosphate of various cations
phosphorous found in the faeces is the non-absorbed
form of phosphorous.
50. Frequent colds and 'flu
Sensitive to pain and noise
Signs of calcium deficiency
Tendency to low blood pressure
Blood is too acid
gingivitis
Red-rimmed eyes
Acute arthritic attacks
INCREASED SERUM PHOSPHATE LEVELS
51. Clinical ImportanceClinical Importance
Hypercalcemia
Elevated serum calcium level up to 12- 15 mg/dl
Conditions leading to hypercalcemia
Hyperparathyroidism
Acute osteoporosis
Thyrotoxicosis
Vitamin D intoxication
54. Hypocalcaemia
Decreased level of calcium in the blood
(<4mg/dl)
Conditions leading to hypocalcaemia
Insufficient dietary calcium
Hypoparathyroidism
Insufficient vitamin D
↑ in calcitonin levels
56. Treatment:
Asymptomatic
Oral calcium and vitamin D supplementation
Symptomatic
IV calcium gluconate (200mg IV over 10min,
then 50-150mg/hr for a total of 15mg/kg)
57. Tetany (Carpopedal spasm)
Basic feature of tetany is uncontrolled,
painful, prolonged contraction (spasm)
of the voluntary muscles.
Chvostek’s sign
Contraction of ipsilateral facial muscles
when tapping facial nerve over the
angle of the mandible.
Erbs sign
◦ Hyperexitability of muscles to electrical stimulation
58. • Trousseau’s sign
• Spasm of the muscles of the upper extremity causing
flexion of wrist and thumb and extension of fingers.
• Clinically can be produced by applying pressure with
sphygmomanometer cuff on the upper arm.
59. Vitamin D deficiencyVitamin D deficiency
Rickets
◦ Occurs in children between 6
months to 2 years of age.
◦ Affects long bones
◦ Lack of calcium causes failure of
mineralization resulting into
formation of cartilagenous form of
bone.
◦ Most critical area that gets affected
is the center endochondral
ossification at the epiphyseal plates.
60. Dental findings in RickettsDental findings in Ricketts
Developmental anomalies of enamel and dentin
Delayed eruption
Misalignment of teeth
Increase caries index
Wide predentin zone and more interglobular
dentin
Treatment
Daily administration of 1000 – 4000 units of vit.D.
61. ◦ Occurs in adults
◦ Flat bones affected
◦ Softening and distortion of skeletal bones
Dental findings
◦ Severe periodontitis
Osteomalacia is softening of the bones, caused by not having
enough vitamin D, or by problems with the metabolism
(breakdown and use) of this vitamin. These softer bones have
a normal amount of collagen that gives the bones its structure,
but they are lacking in calcium
Osteomalacia
62. OsteoporosisOsteoporosis
It is the most common of all bone diseases in adults ,
especially in old age.
It is different from osteomalacia and rickets because
it results from diminished organic bone matrix rather
than from poor bone calcification.
Characterised by low bone mass, microarchitectural
deterioration of bone tissue.
63. Symptoms:
Fractures of brittle bones occur even after minor
accident
Pain due to fractures of vertebrae which may radiate
round the trunk , to the buttocks or down the legs
Oral manifestations include alveolar bone loss
resulting in ill- fitting dentures and periodontitis.
65. HyperparathyroidismHyperparathyroidism
May be Primary or Secondary.
Primary hyperparathyroidism
In Primary form, a primary abnormality of the
parathyroid glands causes inappropriate, excess
PTH secretion.
Caused mainly by an adenoma of parathyroid.
66. • Osteitis fibrosa cystica : Bone pain, joint
stiffness and pathological fracture are the early
symptoms.
• Parathyroid poisoning and Metastatic
calcification
• Hypercalcemia.
• Formation of Kidney stones.
67. Secondary Hyperparathyroidism
In Secondary form, high levels of PTH occur as a
compensation rather than as a primary abnormality
of the parathyroid glands.
It can be caused by Vitamin D deficiency or
chronic renal disease.
68. Oral Manifestations:
Dehydration
Mandibular or maxillary tumors of the bone,
which on biopsy display a brown tumor of von
Recklinghausen
Increasedincidence of tori;
Reduction in indices of cortical bone leading to
osteoporosis(lamina dura and gonial index);
69. According to Schour and Massler, malocclusion
caused by a sudden drifting with definite spacing of
the teeth may be one of the first signs of the disease.
Radiological features include:
Small cystic areas in the calvarium and large/ small
sharply defined radioluscencies may be present in the
maxilla/ mandible, typically described as having a
‘ground glass appearance’.
Lamina dura around the teeth may be partially
lost
Management: involves excision of the parathyroid
tumour
70.
71. HypoparathyroidismHypoparathyroidism
Decrease level of PTH
Due to
◦ Surgical removal of parathyroid gland
◦ Congenital absence of the gland
◦ Atrophy of the gland
Diagnosis
◦ Decrease plasma calcium level & increase plasma phosphate
level
73. •Enamel hypoplasia and dental dysplasia
•Disturbances in tooth eruption
•Root defects
•Hypodontia and impacted teeth
•Large pulp chambers were observed in the
deciduous teeth and the permanent teeth,
•Thickening of the lamina dura was
observed in the permanent teeth.
74. PseudohypoparathyroidismPseudohypoparathyroidism
is the result of defective G protein in kidney and
bone, which causes end-organ resistance to PTH.
there is hypocalcemia and hyperphosphatemia that is
not correctable by administration of exogenous
PTH.
circulating endogenous PTH levels are elevated.
75. Management
Administration of extremely large quantities of
vitamin D, to as high as 100,000 units per day,
along with intake of 1 to 2 grams of calcium,
keeps the calcium ion concentration in a normal
range.
76. • Increased intake Diet containing Vit-D
• Increased release of P from cells (DM, Acidaemia, Starvation)
• Increased release of P from bone (malignancy, Renal failure,
Increased PTH)
• Decreased excretion (Renal failure, Hyperparathyroidism,
Increased growth hormone)
78. Treatment
Treat the underlying cause
In patients with hypoparathyroidism, calcium
and vitamin D supplementation are generally
prescribed to correct hypocalcemia.
In hyperphosphatemia due to chemotherapy for
leukemia or lymphoma, vigorous saline diuresis will
lead to increased phosphaturia. Alternatively, the
administration of acetazolamide, 500 mg every six
hours, will enhance renal phosphate excretion
through urinary alkalinization and natriuresis.
81. Oral manifestations:
Histological evidence of widespread formation of
globular,hypocalcified dentin, with clefts and tubular
defects occuring in the region of pulphorns.
Periapical involvement of grossly normal appearing
deciduous and permanent teeth, followed by the
development of multiple gingival fistulas.
Abnormal cementum and the alveolar bone pattern
Lamina dura is frequently absent or poorly defined.
82. Radiographic features:
Dental radiographs reveal hypocalcification of teeth
and the presence of large pulp chambers and alveolar
bone loss.
Histologic features:
Absence of cementum leading to a lack of sound
attachment of the tooth to the bone by
periodontal ligament. This lack of attachment accounts
for the early spontaneous exfoliation of the deciduous
teeth.
83. Treatment
Treat the underlying cause
A total daily amount of 2 to 3 grams of elemental
phosphorus may be given in two to four divided doses,
orally.
For patients requiring parenteral administration of
phosphate, an initial phosphate dose of 0.08 mmol per
kg body weight may be given over six hours.The dose
may be increased to 0.16 mmol per kg if a patient has
serious life-threatening clinical manifestations.
84. HYPOPHOSPHATASIAHYPOPHOSPHATASIA
The basic disorder is a deficiency of the enzyme
alkaline phosphatase in serum or tissues and
excretion of phosphoethanolamine in the urine.
Clinical features:
Infantile- severe Rickets, Hypercalciemia, Bone
abnormalities and failure to thrive.
85. Childhood- Premature exfoliation of deciduous teeth,
increased infection, growth retardation,
rachitic like deformities, pulmonary, GIT
and renal abnormalities
Adult- spontaneous fractures, prior history of rickets
and osseous radiolucencies.
Oral manifestations:
Loosening and premature loss of deciduous teeth,
chiefly the incisors.
86. Radiographs show hypocalcification of teeth.
Histogically, the teeth present a unique appearance
characterised by the absence of cementum.
Treatment:
Administration of high oral doses of phosphate
results in moderate improvement in bone
calcification.
87. In pagets disease alk.phosphatase levels may
be elevated over 250 bodansky units
It is particularly increased in patients with
osteoblastic phase of disease where there is
Rapid formation of new bone and when there
is polyostotic involvement
Serum Ca & P levels are usually within normal
limits.
88. PSEUDOHYPOPHOSPHATASIA:PSEUDOHYPOPHOSPHATASIA:
A disease resembling classic hypophosphatasia but with
a normal serum alkaline phosphatase level.
Patients exhibit osteopathy of the long bones and skull,
premature loss of deciduous teeth, hypotonia,
hypercalcemia and phosphoethanolaminauria.
89. • It has often been supposed that a low intake of
calcium, or phosphorous, or both might lead to
poor calcification of teeth and possibly, therefore,
to an increased risk of dental caries.
• the calcification of the teeth could be affected if
calcium was very low in the diet.
90. • deficiencies in calcium and phosphate intake do
not affect tooth calcification they do reduce that
of bone, and they result in mobilization of
calcium from already formed bone.
• In pregnancy, when the dietary need of the
mother for calcium and phosphate are increased
by the demands imposed by the growing fetus,
there is mobilization of bone calcium if the
dietary supply is insufficient.
91. ConclusionConclusion
Disturbances in calcium and phosphate intake,
excretion and transcellular shift result in deranged
metabolism accounting for abnormal serum levels.
As a result of the essential role played by these
minerals in intra and extracellular metabolism, the
clinical manifestations of related disease states are
extensive.
Thus, an understanding of the basic mechanism of
calcium, phosphate metabolism and pathophysiology
of various related disorders is helpful in guiding
therapeutic decisions.
92. ReferencesReferences
Textbook of Biochemistry by U. Satyanarayana,
second edition.
Essentials of Medical Physiology by K. Sambulingam,
third edition.
Textbook of Medical Physiology by Guyton and
Hall, tenth edition.
Shafer’s textbook of oral pathology, Fifth edition
Burkets oral medicine 11th
edition
Clinical Disorders of Phosphorous Metabolism,
West J Med. 1987 November; 147(5): 569–576
Calcium and Phosphate Metabolism - Annual
Review of Physiology Vol. 36: 361-390 A B Borle
Editor's Notes
As dentist it is vital for us to have a complete understanding of the general metabolism of Calcium and phosphorus as it is these minerals that help in the formation and the maintenance of the teeth and their supporting bony structure
In growth there is a increased level of growth hormone. GH acts by increasing calcium absorption. It also increases the renal excretion of calcium and phosphates.
The positive balance is obvious in growing child, about 0.1 gm being retained each day in the growing & mineralizing skeleton
The Negative balance arises in later decades of age 50 yrs or more, this can be detected as a loss of skeletal tissue, not merely a reduction in the proportion of mineralization.