Minerals from P.70 to P.80

What are macro-minerals?

Macro-minerals are minerals required by the body in amounts more than 100 mg/dl.

What are the macro-minerals members?

1\.Calcium "Ca++".

2\.Phosphorous "P04---".

3\.Sodium "Na+" and potassium "K+".

4\.Sulfur" S-".

5\.Chloride "CI-".

6\.MagneSium "'Mg++

What are micro-minerals?

Micro-minerals are minerals required by the body in amounts less than 100 mg/dl.

What are essential trace elements?

Essential trace elements are microminerals that must be supplied in the diet, and their deficiency can lead to biochemical abnormalities.

What are the micro-minerals members?

1\. Iron "Fe++".

2\. Zinc "Zn++".

3\. Fluoride "F-".

4\. Selenium "Se++".

5\. Cobalt "Co++".

6\. Molybdenum "Mo".

7\. Copper "Cu++".

8\. Iodine "I-".

9\. Silicon.

10\. Chromium "Cr++".

11\. Manganese "Mn++".

What are the sources of Sodium (Na+)?

Table salt.

What are the sources of Potassium (K+)?

Leafy vegetables, fruits, nuts, cola, and liver.

Where are Sodium (Na+) and Potassium (K+) primarily found in the body?

Sodium: 2/3 in body fluids and tissues as the main intracellular cation. Potassium: 2/3 in body fluids and tissues as the main extracellular cation.

Where is the remaining portion of Sodium (Na+) and Potassium (K+) found in the body?

1/3 in the skeleton (bone & teeth).

What are the plasma levels of Sodium (Na+) and Potassium (K+)?

Plasma Na+ level \= 137-143 mEq/l. Plasma K+ level \= 3.5-5 mEq/l.

When does acute hyperkalemia occur?

Acute hyperkalemia occurs when plasma K+ level is more than 6.5 mEq/l, leading to cardiac arrhythmia and death.

What are the main regulatory hormones for Sodium (Na+) and Potassium (K+)?

Both Na+ and K+ are regulated by adrenal cortical hormones, mainly aldosterone, which increases Na+ reabsorption in exchange for excretion of K+.

What is the role of Sodium (Na+) and Potassium (K+) in maintaining fluid volumes?

Sodium keeps osmotic pressure, plasma volume, and intra-cellular fluid volume, while Potassium keeps extra-cellular fluid volume.

How do Sodium (Na+) and Potassium (K+) regulate acid-base balance?

They contribute to the regulation of acid-base balance through buffer systems.

What is the role of Sodium (Na+) and Potassium (K+) in enzyme activation?

They activate enzymes such as Na+-K+ ATPase, which powers the Na+-K+ exchange pump.

How does Sodium (Na+) aid in glucose transport?

Sodium helps in active glucose transport from the intestinal lumen into enterocytes through the Na+-monosaccharide cotransporter system, followed by passive transport to blood and tissues through the GLUT system.

How do Sodium (Na+) and Potassium (K+) regulate nerve impulse transmission?

They play a role in regulating nerve impulse transmission.

How do Sodium (Na+) and Potassium (K+) regulate neuromuscular excitability?

Neuromuscular excitability increases with an increase in Na+ and K+ levels, and decreases with a decrease in Ca++, Mg++, or H+ levels.

What is the function of Sodium (Na+) and Potassium (K+) in maintaining cell membrane permeability?

They help maintain cell membrane permeability.

How is the normal anion gap maintained?

(Na+ + K+) - (Cl- + HCO3-) \= 16-19.

What does hyponatremia involve?

Hyponatremia involves a decrease in the plasma Na+ level.

What causes hyponatremia in Addison's syndrome?

In Addison's syndrome, hyponatremia is due to aldosterone secretion issues.

What medical condition is associated with hyponatremia due to chronic renal failure?

Chronic renal failure can lead to hyponatremia.

Which type of diuretics can cause hyponatremia?

Thiazide diuretics can lead to hyponatremia.

What is hypotonic dehydration and how does it cause hyponatremia?

Hypotonic dehydration, which involves the loss of water and Na+ with treatment involving water without Na+, can lead to hyponatremia.

What does hypokalemia involve?

Hypokalemia involves a decrease in the plasma K+ level.

What causes hypokalemia in Cushing syndrome?

In Cushing syndrome, hypokalemia is due to increased secretion of glucocorticoids.

What contributes to hypokalemia in Conn's syndrome?

Conn's syndrome results from increased secretion of aldosterone, which leads to increased excretion of K+ and H+ in exchange for reabsorbed Na+.

What medical conditions can lead to hypokalemia due to severe vomiting or diarrhea?

Severe vomiting or diarrhea can lead to hypokalemia.

How does alkalosis contribute to hypokalemia?

Alkalosis can lead to hypokalemia.

Why can treatment of hyperglycemia (DKA) with insulin cause hypokalemia?

Treatment of hyperglycemia (DKA) with insulin without K+ can cause a shift of K+ from the extracellular space to the intracellular space.

Which medications can contribute to hypokalemia?

Diuretics and steroids can cause hypokalemia.

What does hyperkalemia involve?

Hyperkalemia involves an increase in the plasma K+ level.

What is the cause of hyperkalemia in Addison's syndrome?

In Addison's syndrome, hyperkalemia is due to decreased aldosterone secretion.

What medical condition is associated with hyperkalemia due to chronic renal failure?

Chronic renal failure can lead to hyperkalemia.

How does acidosis contribute to hyperkalemia?

Acidosis can cause a shift of K+ from the intracellular space to the extracellular space.

Why can uncontrolled diabetes mellitus lead to hyperkalemia?

Uncontrolled diabetes mellitus can lead to hyperkalemia because the defect of insulin prevents the entry of K+ inside cells.

What is the effect of tissue necrosis on potassium levels?

Tissue necrosis can lead to hyperkalemia due to the leakage of K+ from the contents of damaged tissues.

What are the sources of Magnesium (Mg++)?

Liver, meat, kidneys, fishes, seafood, nuts, and green vegetables.

How much of dietary magnesium is typically absorbed?

Around 40% of dietary magnesium is absorbed, depending on factors like its amount and solubility.

What factors can affect magnesium absorption?

Magnesium absorption depends on its amount, solubility, and the amount of calcium (Ca++) in the diet, as dietary Mg++ competes with Ca++ for absorption.

Where is the majority of magnesium found in the body?

70% of magnesium is found in the skeleton (bone & teeth).

Where is the rest of the magnesium located in the body?

30% is found in the body fluids and other tissues, as magnesium serves as an intracellular cation.

What is the normal plasma level of Magnesium (Mg++)?

The normal plasma level of Mg++ is 2-3 mg/dl.

What is the role of Magnesium (Mg++) in maintaining cell membrane permeability?

Magnesium maintains cell membrane permeability and actively transports other cations such as Na+, K+, and Ca++ across the cell membrane.

How does Magnesium (Mg++) contribute to nerve impulse transmission?

Magnesium is involved in the regulation of nerve impulse transmission.

What is the relationship between Magnesium (Mg++) and neuromuscular excitability?

Magnesium plays a role in regulating neuromuscular excitability.

Why is Magnesium (Mg++) required for muscle contraction?

Magnesium is required for muscle contraction.

How does Magnesium (Mg++) function as a cofactor in metabolic pathways?

Magnesium serves as an important cofactor in various metabolic pathways, such as protein kinases that lead to phosphorylation of certain enzymes. This phosphorylation-dephosphorylation mechanism regulates enzyme activity.

What is hypomagnesemia?

Hypomagnesemia is a decrease in the plasma magnesium level.

Is hypomagnesemia common or rare?

Hypomagnesemia is rare and uncommon.

What are some causes of hypomagnesemia?

1. Dialysis with low magnesium dialysate. 2. Steatorrhea, malabsorption, gut resection. 3. Increased urinary magnesium loss due to renal diseases, alcoholism, intensive diuretic therapy, gentamicin therapy, hyperparathyroidism, and increased production of aldosterone.

What conditions can lead to increased urinary magnesium loss?

Renal diseases, alcoholism, intensive diuretic therapy, gentamicin therapy, hyperparathyroidism, and increased production of aldosterone can all lead to increased urinary magnesium loss.

Does diabetes mellitus (DM) have any association with hypomagnesemia?

Yes, diabetes mellitus (DM) can be associated with hypomagnesemia.

What is hypermagnesemia?

Hypermagnesemia is an increase in the plasma magnesium level.

What can cause hypermagnesemia due to decreased renal excretion?

Decreased renal excretion, such as in cases of renal failure, can cause hypermagnesemia.

Which type of medication consumption can lead to hypermagnesemia?

Increased consumption of medication containing magnesium, such as antacids, can lead to hypermagnesemia.

How does increased magnesium sulfate intake relate to hypermagnesemia?

Increased magnesium sulfate intake, such as in the treatment of pre-eclampsia to reduce the risk of preterm labor and promote fetal growth, can lead to hypermagnesemia.

What is the chemical symbol for sulfur?

Sulfur is represented by the chemical symbol "S".

Name some sulfur-containing compounds in our bodies.

1. Lipids: sulfolipids & bile salts containing taurine. 2. Carbohydrates: sulfur-containing mucopolysaccharides such as chondroitin sulfate, heparin, heparan sulfate, keratan sulfate, and dermatan sulfate. 3. Proteins: Scleroproteins like keratin, collagen, elastin, and reticulin. Sulfur-containing amino acids: cysteine, cystine, methionine, and homocysteine. Ergothionine. Glutathione. 4. Sulfate in urine: Inorganic sulfates like K+, Na+, and Mg++ sulfate. Ethereal sulfate. Indican "potassium-indoxyl sulfate". Thiosulfates, urochrome, mercaptan.

Which hormones contain sulfur?

1. Posterior pituitary hormones: vasopressin & oxytocin. 2. Insulin.

Name some sulfur-containing vitamins.

1. Biotin. 2. Lipoic acid. 3. Thiamine pyrophosphate "TPP". 4. CoASH and its derivatives: acetyl CoA & succinyl CoA.

What are high-energy sulfur-containing compounds?

1. Active methionine "S-adenosyl methionine" (SAM): acts as a methyl donor in transmethylation reactions catalyzed by methyl transferases. 2. 3'-phosphoadenosine-5'-phosphosulfate "PAPS": active form of sulfate which acts as a sulfur donor in sulfation reactions catalyzed by sulfotransferases.

What are some sources of copper?

Nuts, liver, and kidneys are the richest sources of copper.

Where is copper primarily found in the body?

Copper is found in two main body forms: 50% in muscles and 50% in other tissues, including bone.

What is the plasma level of copper?

The plasma level of copper is about 90 µg/dl.

Which protein does copper tightly bind to in the plasma?

Around 90% of copper binds tightly to ceruloplasmin in the plasma.

Which protein does copper loosely bind to in the plasma?

Around 10% of copper binds loosely to albumin in the plasma, and this form is more important in the transport of copper to tissues than ceruloplasmin.

What happens to copper after absorption into the circulation?

After absorption into the circulation, copper is carried by albumin to the liver.

What does copper bind to in the liver?

In the liver, copper binds to apoceruloplasmin to form ceruloplasmin.

How many atoms of copper does one molecule of ceruloplasmin bind tightly to?

One molecule of ceruloplasmin binds tightly to 6 atoms of copper.

What is the role of ceruloplasmin?

Ceruloplasmin has ferroxidase activity, converting Fe++ into Fe+++, which aids in the release of iron from cells.

What are some functions of copper in the body?

1. Copper is important for hemoglobin synthesis, bone formation, and the maintenance of the myelin sheath.

What is the role of copper in enzyme activity?

2. Copper serves as a cofactor for many metabolic enzymes. For example, it is a component of Superoxide dismutase (SOD), which is responsible for detoxifying superoxide ions (O2•-) formed during aerobic metabolism.

Where is Superoxide dismutase (SOD) found in the body, and what does it do?

SOD, containing copper, zinc, and manganese, is found throughout the body in different tissues under various names (e.g., erythrocuprein in R.B.Cs, hepatocuprein in the liver, cerebrocuprein in the brain). It detoxifies superoxide ions formed during aerobic metabolism.

What is hypercupremia?

Hypercupremia refers to an increase in plasma copper and ceruloplasmin levels. Ceruloplasmin, an acute phase protein, increases in response to malignancy and both acute and chronic infections.

What is hypocupremia?

Hypocupremia refers to a decrease in plasma copper and ceruloplasmin levels.

What is aceruloplasminemia?

Aceruloplasminemia is a genetic disorder characterized by very low levels of plasma ceruloplasmin, leading to decreased ferro-oxidase activity. This results in the failure to release iron from cells, leading to iron accumulation in various organs such as the liver, pancreas, and skin.

What are the consequences of aceruloplasminemia?

Aceruloplasminemia can lead to liver cirrhosis, diabetes mellitus (D.M.), and bronzed pigmentation of the skin.

What are the treatment options for aceruloplasminemia?

Treatment involves the use of iron chelating agents and the administration of plasma ceruloplasmin.

What is Menke's disease, and who does it primarily affect?

Menke's disease, also known as "steely or kinky hair disease," is an X-linked disease that primarily affects males.

What is the main characteristic of Menke's disease?

Menke's disease is characterized by a failure of copper efflux, leading to its accumulation in the brain, connective tissues, and vasculature. The liver retains some ATPase activity, preventing copper accumulation there.

What are the consequences of excess copper accumulation in Menke's disease?

Excess copper can lead to lipid and protein oxidation, binding to nucleic acids, and enhancing free radical formation.

What is Wilson's disease (Hepatolenticular degeneration)?

Wilson's disease is characterized by the failure of copper excretion into the bile, resulting in copper accumulation in the liver. This leads to liver cirrhosis and various other symptoms.

What are the manifestations of Wilson's disease?

1. Kayser-Fleischer ring (greenish-brown discoloration at the corneal margin) in the eyes. 2. Degeneration of the lenticular nucleus with abnormal movement in the brain. 3. Renal tubular damage with increased excretion of copper and ceruloplasmin in urine. Also, increased excretion of amino acids in urine, leading to aminoaciduria.

What are some functions of zinc in the body?

1. Zinc is essential for normal growth, reproduction, bone formation, and the regulation of gene expression at the transcription level through its involvement in the zinc finger motif.

What role does zinc play in wound healing and tissue repair?

2. Zinc is essential for wound healing, tissue repair, and the integrity of nails and hair.

How does zinc affect the mobilization of vitamin A?

3. Zinc aids in the mobilization of vitamin A from the liver, helping to maintain normal plasma vitamin A levels.

What is the interaction between zinc and insulin?

4a. In vivo, zinc complexes with insulin, aiding in the crystallization, storage, and release of insulin.

4b. In vitro, if zinc is injected along with insulin, it can prolong the duration of insulin action.

What enzymes require zinc as a cofactor?

Zinc serves as a cofactor for various enzymes, including RNA and DNA polymerases required for RNA and DNA synthesis.

What is the role of zinc in the enzymes 6-Aminolevulinic acid dehydratase and SOD?

Zinc is a cofactor for 6-Aminolevulinic acid dehydratase and SOD (Super Oxide Dismutase), as mentioned before.

Which dehydrogenases require zinc as a cofactor?

Zinc is required as a cofactor for several dehydrogenases, including: a) Lactate dehydrogenase (LDH) b) Malate dehydrogenase c) Alcohol dehydrogenase

What is the role of carbonic anhydrase?

Carbonic anhydrase is a metalloprotein that catalyzes the reversible production of carbonic acid from CO2 and H2O.

What metal is present in the structure of carbonic anhydrase?

Zinc is present in the structure of carbonic anhydrase, making it a metalloprotein.

Why is carbonic anhydrase important in the body?

Carbonic anhydrase is crucial for the formation of the bicarbonate buffer system, which is the most important and efficient physiological buffer in the body.

What is the composition of the bicarbonate buffer system?

The bicarbonate buffer system is composed of H2CO3/Na+ or K+HCO3-. It serves as the body's alkali reserve and can neutralize added acids to the blood to some extent.

What is osteopetrosis, and what are its characteristics?

Osteopetrosis, also known as marble bone disease, is characterized by an increase in bone density, which exerts pressure on nerves such as the optic nerve and spinal cords at different levels. This pressure can lead to blindness or quadriplegia/hemiplegia.

What is the genetic basis of osteopetrosis?

Osteopetrosis is caused by a mutation in the gene encoding carbonic anhydrase II (CA-II). Carbonic anhydrase II has four isoenzymes found in bone, brain, kidneys, and eyes. In bone, this enzyme is present in osteoclasts and plays a role in bone resorption.

What is the consequence of carbonic anhydrase II deficiency in bone?

Deficiency of carbonic anhydrase II leads to a failure of bone resorption, contributing to the increased bone density observed in osteopetrosis.