This document discusses calcium homeostasis and provides information on: - Recommended daily calcium intake amounts for different age groups and conditions. - How calcium is absorbed in the intestines and regulated by parathyroid hormone and vitamin D. - The roles of parathyroid hormone, vitamin D, and calcitonin in maintaining calcium levels. - Symptoms of hypercalcemia and hypocalcemia. - Causes and treatment of hypocalcemia.

1. Calcium Homeostasis

2. 2

3. 3

5. RDA - Calcium
 Adult-500mg/day
 Child-1200mg/day
 Pregnancy and lactation-1500mg/day
 >50yrs - calcium(1500mg/day)+vit.D (20
mg/day)

6. ABSORPTION

7. 7

8. 8

9. Hormones and Calcium Homeostasis
▪ “Parathyroid hormone (PTH) and vitamin D are the
two hormones that play the dominant role in the
regulation of calcium homeostasis”
9

10. Parathyroid Glands

11. Parathyroid Hormone
▪ Has 84 amino acids – Secreted by Parathyroid glands
▪ The first 35 amino acids of PTH are biologically active
▪ Control of release of the hormone is by negative feedback by the
ionized calcium in serum
▪ The release of hormone is mediated by cyclic AMP
▪ The normal PTH level in serum is 10–60 ng/L
▪ Mechanism of Action of Parathyroid Hormone
▪ PTH activates adenylyl cyclase with consequent increase in
intracellular calcium concentration.
11

12. Actions of PTH
1) PTH and bones
▪ In the bone, PTH causes demineralization.
▪ The numbers of osteoclasts are also increased.
▪ Osteoclasts release lactate which solubilizes calcium.
2) PTH and kidney
▪ In kidney, PTH causes decreased renal excretion of calcium and
increased excretion of phosphates.
3) PTH and intestines:
PTH stimulates 1-hydroxylation of 25-hydroxycalciferol in kidney to
produce calcitriol. This indirectly increases calcium absorption.
12

13. VITAMIN D
 Metabolic product of the cholesterol synthetic
pathway.
 The tissues that are involved in the synthesis of
vitamin D are the skin, liver, and kidneys and the
tissues it affects are the gut, bone, and
parathyroids
13

14. Formation of Calcitriol
14

15. 15

16. 17

17. Calcitonin
▪ A Polypeptide - secreted by the thyroid parafollicular or clear cells.
▪ Decreases serum calcium level.
▪ Inhibits resorption of bone (decreases the activity of osteoclasts
and increases that of osteoblasts)
▪ Calcitonin and PTH are directly antagonistic.
▪ PTH and Calcitonin together promote the bone growth and
remodeling.
18

18. 19
Comparison of action of three major factors affecting serum calcium
Vitamin D PTH Calcitonin
Blood calcium Increased Drastically
increased
Decreased
Main action Absorption
from gut
Demineralisation Opposes
Demineralisation
Calcium absorption from gut Increased Increased (indirect)
Bone resorption decreased Increased decreased
Deficiency manifestation Rickets Tetany --
Use in rickets drug of choice contraindicated theoretically
beneficial
Effect of excess Hypercalcemia
+
Hypercalcemia++ Hypocalcemia

19. ▪ Actions:
1)increase Ca absorption from intestine.
2) increase PO4 absorption from intestine.
3) increase renal reabsorption of Ca &PO4.
4) increase bone resorption from old bone &mineralize
new bone {net resorption} .
 Overall effect : ↑ serum Ca & PO4 .
Vitamin D

20. 21

21. Calcium in cells
Calcium is mainly extra-cellular, but also present in
intracellular compartment
Entry into cells:
▪ Calcium influx by Na/Ca exchange mechanism
▪ Entry of calcium into mitochondria by a calcium uniport
system

22. Exit out of cells
▪ By Na-Ca antiport system, which in turn is
dependent on the Na-H-ATPase pump, this is
called calcium pump
Other calcium channel
▪ Voltage operated channel, second messenger
operated channel

23. function
Secretio
n of
hormon
es
Nerve
conducti
on
muscles
Activati
on of
enzyme
s
Second
messen
ger
Vascular
permeabil
ity
Coagulati
on
Myocardi
um
Bone
and
teeth

24. Functions of calcium
1) Activation of enzyme
▪ Calmodulin mediated activation
▪ Direct activation by calcium
▪ CALMODULIN:
 Calcium binding regulatory protein.
 Bind with 4 calcium ions.
 Calcium binding leads to activation of enzymes.

25. Calcium + Calmodulin
ca-bound calmodulin
Kinase -------------> active kinase
Enzyme------------------PHOSPHORYLATED
ENZYME
Biological Effect
MECHANISM OF ACTION OF CALMODULIN

26. 27
Substances activated directly by Calcium
▪ Pancreatic lipase
▪ Enzyme of coagulation pathway
▪ Renin

27. Muscle
▪ Mediates excitation and contraction of
muscle fibres.
28

28. 29
Upon getting the Neural signal
Calcium released from sarcoplasmic reticulum
Calcium activates ATPase
Increases action of actin and myosin
Excitation –contraction coupling.

29. 30
▪ Trigger by interaction of calcium with Troponin C
▪ The Active Transport System utilizing calcium
binding protein is called calsequestrin
▪ Ca decreases neuromuscular irritability
▪ Deficiency-Tetany

30. NERVE CONDUCTION
▪ Transmission of Nerve Impulses From
Pre Synaptic Post Synaptic

31. SECRETION OF HORMONES
▫ INSULIN
▫ PARATHYROID HORMONE
▫ CALCITONIN
▫ VASOPRESSIN

32. SECOND MESSENGER
Calcium and cyclic AMP are second messenger of
different hormone
eg: Glucagon
Calcium is used as second messenger in systems
involving G proteins and Inositol triphophate.
33

33. Vascular permeability
Decreases serum passage through capillaries.
▫ USE: Reduce allergic exudates

34. COAGULATION:
• Factor IV (ca) – Blood coagulation cascade
• Prothrombin contain gamma carboxy glutamate
residues – Chelated by calcium during thrombin
formation

35. Myocardium
Calcium prolongs SYSTOLE
In hypercalcemia, cardiac arrest is seen in systole
This fact should be kept in mind before giving it
Intravenously (Should be given very slowly)
36

36. Bone and teeth
The bulk quantity of calcium is used for bone and
teeth formation
Bone also act as reservoir for calcium the body
Osteoblast- bone deposition
Osteoclast-demineralization
37

37. Calcium in blood
▪ Normal blood level:9 – 11mg/dl
▪ Ionized calcium :5mg/dl metabolically active.
▫ 1mg/dl complexed with
phosphate,bicarbonate,citrate.
▪ Protein bound calcium: 4mg/dl protein bound. Non
diffusible.
38

38. 39

39. 40

40. Clinical Features
41

41. Hypercalcemia- Signs and Symptoms
42

42. “ Painful Bones, Renal Stones, Abdominal Groans,
Psychic Moans and Neuro-Psychiatric over-tones”
43
Clinical Features

43. 44

44. Causes of Hypocalcemia
1. Deficiency of vitamin D
▪ Decreased exposure to sunlight
▪ Malabsorption, dietary deficiency
▪ Hepatic diseases
▪ Decreased renal synthesis of calcitriol
▪ Nephrotic syndrome (binding protein lost)
▪ Anticonvulsant therapy
2. Deficiency of parathyroid
▪ Hypoparathyroidism (primary, secondary)
3. Increased calcitonin
▪ Medullary carcinoma of thyroid
45

45. ▪ 4. Deficiency of calcium
▪ Intestinal malabsorption
▪ Acute pancreatitis
▪ Alkalosis decreasing ionized calcium
▪ 5. Deficiency of magnesium
▪ 6. Increase in phosphorus level
▪ Renal failure
▪ Phosphate infusion
▪ Renal tubular acidos
46
Causes of Hypocalcemia

46. Symptoms of hypocalcemia
47
1. Muscle cramps
2. Paresthesia, especially in fingers
3. Neuromuscular irritability, muscle twitchings
4. Tetany (Chvostek’s sign, Trousseau’s sign)
5. Seizures
6. Bradycardia
7. Prolonged QT interva

47. Treatment of Hypocalcemia
48
1. Oral calcium, with vitamin D supplementation
2. Underlying cause should be treated
3. Tetany needs IV calcium (usually 10 mL 10% calcium
gluconate over 10 minutes, followed by slow IV infusion).
IV calcium should be given only very slowly

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51. 52

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Yellow
Is the color of gold, butter and
ripe lemons. In the spectrum of
visible light, yellow is found
between green and orange.
Blue
Is the colour of the clear sky
and the deep sea. It is located
between violet and green on
the optical spectrum.
Red
Is the color of blood, and
because of this it has
historically been associated
with sacrifice, danger and
courage.
Yellow
Is the color of gold, butter and
ripe lemons. In the spectrum of
visible light, yellow is found
between green and orange.
Blue
Is the colour of the clear sky
and the deep sea. It is located
between violet and green on
the optical spectrum.
Red
Is the color of blood, and
because of this it has
historically been associated
with sacrifice, danger and
courage.
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DEC
NOV
OCT
SEP
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JUL
JUN
MAY
APR
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FEB
JAN
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Red is the colour of
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Yellow is the color of
gold, butter and ripe
lemons
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the clear sky and the
deep sea
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gold, butter and ripe
lemons
White is the color of
milk and fresh snow
Blue is the colour of
the clear sky and the
deep sea
Red is the colour of
danger and courage
Black is the color of
ebony and of outer
space
Yellow is the color
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ripe lemons

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73
1 3 5
6
4
2
Blue is the colour of the
clear sky and the deep sea
Red is the colour of danger
and courage
Black is the color of ebony
and of outer space
Yellow is the color of gold,
butter and ripe lemons
White is the color of milk
and fresh snow
Blue is the colour of the
clear sky and the deep sea

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Week 1 Week 2
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75
STRENGTHS
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WEAKNESSES
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Black is the color of ebony
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White is the color of milk and
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