This document discusses calcium and phosphorus, two important minerals in the human body. It provides information on their sources, functions, and relationship to other minerals and hormones like vitamin D and parathyroid hormone. Specifically, it explains that calcium and phosphorus are required for bone strength, cell functions, muscle contractions, and other metabolic processes. It also outlines how calcium levels in the blood are regulated through homeostasis and what can cause hypocalcemia or low calcium levels in the blood.

3. • NOOR FAIZA😎
• HAFSA KHALID😉
• SHAIQA ZAFAR 😍
• AQSA MUSHTAQ 🙂
• MARYAM KHALID😁
• LAIBA ROOP PAUL 😂
GROUP MEMBERS:

4. MINERALS
• CALCIUM AND PHOSPHORUS are basically minerals.
“Minerals are naturally-occurring inorganic
substances with a definite and predictable
chemical composition and physical properties”

5. WHAT IS CALCIUM?
• Calcium is a chemical element which is
essential for living organisms, including
humans. Calcium is a mineral found in many
foods.
• Calcium's chemical symbol is "Ca".
• We need to consume a certain amount of
calcium to build and maintain strong bones
and healthy communication between the
brain and various parts of the body.

6. • Calcium is one of the
body's electrolytes, which
are minerals that carry an electric
charge when dissolved in body
fluids such as blood (but most of
the body's calcium is uncharged).
• It is required for activation of
several enzymes such as succinate
dehydrogenase, ATPase and
certain proteolytic enzymes.

8. WHAT IS PHOSPHORUS ?
• Phosphorus is the second most plentiful mineral in our body. The first
is calcium. Our body needs phosphorus for many functions, such as
filtering waste and repairing tissue and cells.

10. What Does CALCIUM Do?
Calcium(Ca) is required for the :
• Muscle contraction,
• Nerve conduction,
• Hormone release,
• Blood coagulation
• In addition, specific Calcium concentration
is required for various other metabolic processes.

11. SOURCES OF

12. Calcium Sources in Food
• Milk and dairy products are not the only sources of calcium. Here is a
list of foods that are good sources of calcium:

13. Food Amount
Calcium (milligrams)
Yogurt, plain, low fat 8 oz 415
Collards, frozen, boiled 1 cup 357
Skim milk 1 cup 306
Yogurt, plain, whole milk 8 oz 275
Black-eyed peas, boiled 1 cup 211
Canned salmon 3 oz 181
Calcium-set tofu 3 oz (¼ block) 163
Cheese food, pasteurized 1 oz 162
Trail mix (nuts, seeds, chocolate chips) 1 cup 159
Baked beans, canned 1 cup 154
Cottage cheese, 1% milk fat 1 cup 138
Iceberg lettuce 1 head 97
Green peas, boiled 1 cup 94
Soy milk 1 cup 93
Oranges 1 cup 72
Almonds 1 oz (24 nuts) 70

14. Sources of PHOSPHORUS

15. Some of the main sources of phosphorus are:
• Seeds (Pumpkin & Squash)
• Cheese (Romano)
• Fish (Salmon)
• Shellfish (Scallops)
• Nuts (Brazil)
• Beef & Veal (Lean Beef)
• Low Fat Dairy (Nonfat Yogurt)
• Soya Foods (Tofu)
• Beans & Lentils

16. Functions of Calcium
• Calcium salts provide rigidity to the skeleton. Calcium phosphate is a
major component of the mineral complex (called hydroxyapatite) that
gives structure and strength to bones.
• Many neuromuscular and other cellular functions depend on the
maintenance of the ionized calcium concentration in the ECF.
• Blood clotting
• absorbing vitamin B12

17. Calcium Homeostasis
• Calcium homeostasis refers to the regulation
of the concentration of calcium ions in the
extracellular fluid [Ca++]ECF. This parameter is
tightly controlled because the calcium ions
have a stabilizing effect on voltage-gated ion
channels.
• For instance, when [Ca++]ECF is too low
(hypocalcemia), voltage-gated ion channels
start opening spontaneously, causing nerve
and muscle cells to become hyperactive. The
syndrome of involuntary muscle spasms due
to low [Ca++]ECF is called hypocalcemic tetany.

18. • Conversely, when [Ca++]ECF is too high (hypercalcemia), voltage-gated
ion channels don't open as easily, and there is depressed nervous
system function.Another problem of hypercalcemia is that calcium can
combine with phosphate ions, forming deposits of calcium
phosphate (stones) in blood vessels and in the kidneys

20. Calcium pumps
• Calcium pumps are a family of ion transporters found in the cell membrane of all
animal cells.
• They are responsible for the active transport of calcium out of the cell for the
maintenance of the steep Ca2+ electrochemical gradient across the cell
membrane.
• Calcium pumps play a crucial role in proper cell signalling by keeping the
intracellular calcium concentration roughly 10,000 times lower than the
extracellular concentration.
• Failure to do so is one cause of muscle cramps.
• There are two calcium ATPase:
1. The plasma membrane Ca2+ ATPase and the sodium-calcium exchanger are
together the main regulators of intracellular Ca2+ concentrations.
2. sarcoplasmic reticulum calcium atpase

21. What Does Phosphorus Do?
You need phosphorus to keep your bones strong and healthy, to help make energy, and to
move your muscles.
In addition, phosphorus helps to:
• build strong bones and teeth
• filter out waste in your kidneys
• manage how your body stores and uses energy
• grow, maintain, and repair tissue and cells
• produce DNA and RNA — the body’s genetic building blocks
• balance and use vitamins such as vitamins B and D, as well as other minerals like iodine,
magnesium, and zinc
• assist in muscle contraction
• maintain a regular heartbeat
• facilitate nerve conduction
• reduce muscle pain after exercise

22. Secondary Functions of Phosphorus
• Phosphorus also acts as a buffer, neutralizing acids to maintain
normal pH in the blood. Many enzymes and hormones also contain
phosphorus as a structural component. Hemoglobin, the important
oxygen-carrying protein in the bloodstream, also depends upon
phosphorus contained in its structure for proper function.

23. Vitamin D
• Vitamin D helps in absorption of calcium and phosphorus.
• Vitamin D is called a ‘vitamin’ because of its exogenous source, predominately
from oily fish in the form of vitamin D2 and vitamin D3.
• It is really a hormone, synthesized by the skin and metabolized to an active
hormone, calcitriol, by the kidney which then acts throughout the body.
• In the skin, 7-dehydrocholesterol is converted to vitamin D3 in response to sun
light, a process that is inhibited by sunscreen of SPF 8 or greater.
• Once in the blood, vitamin D2 and D3 from diet or skin bind with vitamin D
binding protein, and carried to the liver where they are hydroxylated to yield
25(OH)D, often called calcidiol. Calcidiol is then converted in the kidney to
1,25(OH)2D by the action of 1α-hydroxylase.
• The 1α-hydroxylase in the kidney is regulated by nearly every hormone involved
in calcium homeostasis, and its activity is stimulated by PTH, estrogen, calcitonin,
prolactin, growth hormone, low calcium and low phosphorus. Its activity is
inhibited by calcitriol, thus providing the ‘feedback’ loop that regulates calcitriol
synthesis.

24. • The most important function is exerted on
the small intestine, where calcitriol regulates
the intestinal absorption of calcium and, to a
lesser degree, phosphorus and inhibits PTH
synthesis at the parathyroid gland.
• The most important role of vitamin d is to
maintain skeletal Calcium balance by
promoting Ca absorption in intestine.
• Promoting bone reabsorption by increasing
osteoclasts number.
• Maintenance of calcium and phosphate
levels for bone formation.
• Allowing proper functioning of parathyroid
harmone.

26. Parathyroid Hormone
• A decrease in ionized calcium stimulates a release of parathyroid hormone
(PTH), which maintains calcium homeostasis by 1) increasing bone mineral
dissolution, thus releasing calcium and phosphorus, 2) increasing renal
reabsorption of calcium and excretion of phosphorus, and 3) enhancing the
gastrointestinal absorption of both calcium and phosphorus indirectly
through its effects on the synthesis of 1,25(OH)2D (calcitriol).
• In healthy subjects, this increase in serum PTH level in response to
hypocalcemia effectively restores serum calcium levels and maintains
normal serum phosphorus levels. PTH also enhances the conversion of
calcidiol [25(OH)-vitamin D] to calcitriol, which in turns decreases PTH
secretion at the level of the parathyroid glands completing the typical
endocrine feedback loop

27. CLINICAL SIGNIFICANCE OF CALCIUM
• Deficiency of calcium can lead to weaker bones, tetany and seizures.
• Deficiency can occur due to poor intake, malabsorption, vitamin D
deficiency, hypoparathyroidism and renal disease.
• Long term Deficiency can lead to osteomalacia and osteoporosis.

28. CLINICAL SIGNIFICANCE OF CALCIUM
• HYPOCALCEMIA
Definition
“Hypocalcemia is an electrolyte imbalance in
which the serum, or blood, calcium level is
below the normal range. The normal serum
calcium level is 8.5-10.5 mg/dl.”

30. Conditions:
• Other conditions resulting to hypocalcemia are chronic liver disease, nephrotic
syndrome, congestive heart failure, and malnutrition, osteomalacia and
rickets, etc. but common causes are chronic renal failure and
hypomagnesemia.
• In chronic renal failure, hypoproteinemia, hyperphosphatemia, low serum
vitamin D (reduced synthesis because of inadequate renal mass) and/or
skeletal resistance to PTH contribute to hypocalcemia. Magnesium deficiency
impairs PTH secretion and cause PTH end-organ resistance. Inherited
resistance of PTH leads to pseudohypoparathyroidism and thus hypocalcemia
e.g. in pseudohypoparathyroidism type I (Albright’s hereditary
osetodystrophy) is due to reduction in guanine nucleotide regulatory complex
in adenylate cyclase complex. Vitamin D deficiency is also associated with
hypocalcemia and is due to impaired intestinal absorption of calcium and
skeletal resistance to PTH. Clinically hypocalcemia presents with
neuromuscular hyperexcitability, such as tetany, paresthesia, and seizures.

31. • Causes of Hypocalcemia
• Hypocalcemia most commonly results when too much calcium is lost in urine or
when not enough calcium is moved from bones into the blood. Causes of
hypocalcemia include the following:
• A low level of parathyroid hormone (hypoparathyroidism), as can occur when
the parathyroid glands are damaged during thyroid gland surgery
• Lack of response to a normal level of parathyroid hormone
(pseudohypoparathyroidism)
• No parathyroid glands at birth (for example, in DiGeorge syndrome)
• Vitamin D deficiency (due to inadequate consumption or inadequate exposure
to sunlight)
• Kidney dysfunction, which results in more calcium excreted in urine and makes
the kidneys less able to activate vitamin D
• Inadequate consumption of calcium
• Disorders that decrease calcium absorption

32. Severe symptoms of calcium deficiency disease include:
• confusion or memory loss.
• muscle spasms.
• numbness and tingling in the hands, feet, and face.
• depression.
• hallucinations.
• muscle cramps.
• weak and brittle nails.
• easy fracturing of the bones.

33. Treatment of Hypocalcemia
• Calcium supplements
• Sometimes vitamin D
• Calcium supplements, given by mouth, are often
all that is needed to treat hypocalcemia. If a cause
is identified, treating the disorder causing
hypocalcemia or changing drugs may restore the
calcium level.

34. Hypercalcemia (Elevated Calcium Levels)

36. What are the causes of hypercalcemia?
• One of the most common causes of high calcium levels (hypercalcemia), is
an overproduction of parathyroid hormone, or hyperparathyroidism.
• Hyperparathyroidism tends to be more common in women over 50.
• It can be the result of all four parathyroid glands producing too much PTH
(parathyroid hyperplasia), or one gland specifically producing an excessive
amount of hormone (usually the result of a parathyroid adenoma, or
benign tumor).
• Hypercalcemia can occur due to other medical conditions. These
conditions can vary in severity and chronicity, and may be life-
threatening. Malignancy is a common cause of elevated blood calcium. Up
to 20% of individuals with cancer will develop hypercalcemia at some point
in their disease.

37. What Are the Symptoms of Hypercalcemia?
You might not have any symptoms if you have mild hypercalcemia. If you have a more serious case,
you might have symptoms that affect various parts of your body.
Kidneys
Symptoms related to your kidneys can lead to:
• excessive thirst
• excessive urination
• pain between your back and upper abdomen on one side
Abdomen
Symptoms related to the abdomen include:
• nausea
• abdominal pain
• decreased appetite
• constipation
• vomiting

38. Muscles
• Calcium levels can affect your muscles, causing twitches and
weakness.
Skeletal System
High calcium levels can also cause bone issues, including:
• bone pain
• height loss
• bowed shoulders
• curvature of the spine
• fractures from disease

39. • Psychological Symptoms
• Hypercalcemia can also cause
psychological symptoms, such
as depression, memory loss,
and irritability.

40. TREATMENT
• Severe Cases
You might need hospital treatment if you have a severe case. The goal of treatment
is to return your calcium level to normal. Treatment also aims to prevent damage to
your bones and kidneys. Treatment options include the following:
• Calcitonin is a hormone produced in the thyroid gland. It slows down bone loss.
• Intravenous fluids keep you hydrated.
• Corticosteroids are anti-inflammatory medications. They help your body handle
having too much vitamin D.
• Loop diuretic medications can help your kidneys function and get rid of extra
calcium.
• Intravenous bisphosphonates can keep your bones from breaking down.
• Dialysis can be given to rid your blood of extra calcium and waste when you have
damaged kidneys. This is only done if other treatment methods aren’t working.

41. CLINICAL SIGNIFICANCE OF PHOSPHORUS

42. Hyperphosphatemia
• Hyperphosphatemia—that is, abnormally high serum phosphate
levels—can result from increased phosphate intake, decreased
phosphate excretion, or a disorder that shifts intracellular phosphate
to extracellular space

43. Persons who are at risk for increased
phosphorus levels
• Kidney disease: Past or present hemodialysis; adherence to renal (low
phosphorus) diet; use of oral phosphate binders
• Cancer: Leukemia, lymphoma, bone tumors, other cancers,
chemotherapy treatment
• Endocrinopathies (hypoparathyroidism and
pseudohypoparathyroidism)
• Trauma Burns or heat-related illnesses Prolonged immobilization
Metabolic or hematologic disorders, including genetic predisposition
• Ischemic bowel (possible phosphorus elevations)

44. signs and symptoms
• Fatigue
• Shortness of breath
• Anorexia
• Nausea
• Vomiting
• Sleep disturbances

45. Primary hyperparathyroidism
Primary hyperparathyroidism occurs because of some problem with
one or more of the four parathyroid glands:
• A noncancerous growth (adenoma) on a gland is the most common
cause.
• Enlargement (hyperplasia) of two or more parathyroid glands
accounts for most other cases.
• A cancerous (malignant) tumor is a rare cause of primary
hyperparathyroidism.
• Primary hyperparathyroidism usually occurs randomly, but some
people inherit a gene that causes the disorder.

46. Secondary hyperparathyroidism
• Secondary hyperparathyroidism is the result of another condition that lowers calcium
levels.
• Therefore, your parathyroid glands overwork to compensate for the loss of calcium.
Factors that may contribute to secondary hyperparathyroidism include: Severe calcium
deficiency.
• Your body may not get enough calcium from your diet, often because your digestive
system doesn't absorb the calcium from it. Severe vitamin D deficiency.
• Vitamin D helps maintain appropriate levels of calcium in the blood, and it helps your
digestive system absorb calcium from your food. Your body produces vitamin D when
your skin is exposed to sunlight, and you consume some vitamin D in food. If you don't
get enough vitamin D, then calcium levels may drop. Chronic kidney failure. Your kidneys
convert vitamin D into a form that your body can use.
• If your kidneys function poorly, usable vitamin D may decline and calcium levels drop.
Chronic kidney failure is the most common cause of Secondary hyperparathyroidism

47. Hypophosphatemia
• Hypophosphatemia is a serum phosphate concentration < 2.5 mg/dL
(0.81 mmol/L).
• Causes include alcoholism, burns, starvation, and diuretic use. Clinical
features include muscle weakness, respiratory failure, and heart
failure; seizures and coma can occur. Diagnosis is by serum phosphate
concentration. Treatment consists of phosphate supplementation.

48. Severe chronic hypophosphatemia usually results from a prolonged
negative phosphate balance.
Causes include :
• Chronic starvation or malabsorption, often in patients with
alcoholism, especially when combined with vomiting or copious
diarrhea
• Long-term ingestion of large amounts of phosphate-binding
aluminum, usually in the form of antacids