Cellular and Extracellular

Calcium Metabolism

Asep Harirohman
 Calcium
: Calcium is the most abundant mineral in the body

about 1 kg in a 70 kg man

of the body’s calcium is present in the bone 99%~

where it is combined with phosphate
 Dietary Sources of Calcium

: Rich
Milk, milk products as cheese & yoghurt

Fair
Legumes, vegetables
 Biological Functions of Calcium
Bone Formatio
n

99 % Reservoir for E

CF [Ca2+]
in bone
Total
Blood Clotting
Calcium
Of the ECF
Body Excitability of Ne
rve & Muscle

1%
Metabolic Regulati
on for Action of Ho
rmones & Enzyme
ICF Activation
Calcium in Blood
 Calcium in Blood

Only ionized regulated by PTH & Calcitriol-

Whole blood  anticoagulant citrate -
decrease Ca Ion  tetany
Organ Calcium Homeostasis
 . Organ Calcium Homeostasis cont

&The concentration of calcium, phosphorous

magnesium in the plasma depends on
:ORGAN PHYSIOLOGY

Net effect of bone mineral deposition & resorption

Intestinal absorption
Renal excretion
 Endocrinal Calcium Homeostasis

 Parathyroid Hormone (PTH)

Blood
 Active Vitamin D (Calcitriol or 1,25 DHCC)
[Ca2+]
is Regulated By
 Calcitonin Hormone
:
Parathyroid hormone (PTH)
 Parathyroid hormone (PTH)

:Paratiroid Gland
Sel epitelial (chief cell, oxyphil cell)-
Stromal fat-

Regulated by calcium  negative feedback-

Reseptor CaSR-
Mutasi CaSR  Familial Hipocalciuric Hipercalcemia-
 Parathyroid hormone (PTH)

:Other regulator
Hipermagnesemia-
MgSO4 infusion-
Cathecolamine-
Pheocromositoma  PTHrP-
Calcitriol  CKD-
 Functions of Parathyroid Hormone (PTH)

The active hormone is secreted in response to al fall in plasma Ca2+

. resulting in in Ca2+ increase in blood

: On bone
PTH stimulates bone resorption by osteoclasts resulting in release of
calcium ions from bones to blood in cases of hypocalcemia

: On kidney
.PTH increases reabsorption of calcium from kidney tubules- 1
PTH promotes activity of 1hydroxylase of the kidney (with more- 2
hydroxylation of 25 hydroxycholecalciferol (25 HCC) to 1,25 DHCC
which increases intestinal absorption( activation of vitamin D )
of
calcium
So, action of PTH on intestine is indirect (via Vitamin D)
 Role of Parathyroid Hormone (PTH) in
Hypocalcemia

PTH
is the principal
acute regulator of b
lood [Ca2+]

PTH
is a hypercalcemic
hormone in case of
hypocalcemia
Regulation of PTH
Vitamin D
 Vitamin D
.A group of sterols with a hormone-like function
Sources of Vitamin D
:Skin synthesis (On Exposure to Sun Lights)- 1
In the skin, 7 dehydrocholesterol is converted to vitamin D3 by exposure to
sunlight
:Diet- 2
Animal Source Cholecalciferol (Vitamins D3) -
Plant Source: Ergocalciferol (Vitamin D2) -
Vitamin D2 & D3 are NOT biologically active

Activation of cholecalciferol (vitamin D3)

Cholecalciferol (Vitamin D3) is activated in the body to the biologically active
form by two hydroxylations: first in the liver (at position 25) by 25 hydroxylase
then in the kidney at positions 1 by 1 α hydroxylase &
Active Vitamin D
dihydroxycholecalciferol (Calcitriol or DHCC) 25, 1
SOURCES OF VITAMIN D
Vitamin D2
plant source

DIET VITAMINs D

Vitamin D3
animal source
fatty fish
Liver
egg yolk

Sun
Rays

7-dehydrocholesterol
In the skin
 Vitamin D metabolism
Cholecalciferol (Vitamin D3) is derived from 7-dehydrocholesterol in
the skin by sunlight or supplied in the diet

:In liver
Cholecalciferol is converted to 25-hydroxycholecalciferol (25-HCC)
by the enzyme 25 hydroxylase

hydroxycholecalciferol is the predominant form of vitamin D-25

in blood
hydroxycholecalciferol is the main storage form of vitamin-25
in the body

:In kidneys
The 1 α hydroxylase enzyme converts 25 hydroxycholecalciferol to
dihydroxycholecalciferol (1, 25 DHCC or Calcitriol)-1,25
which is the biologically active form of vitamin D
A simplified schema for the regulation of serum phosphate by PTH, 1,25
(0H)2D and fibroblast growth factor 23 (FGF23)
Mechanism of Action of Vitamin D
 Functions of Vitamin D

Active vitamin D (1, 25 DHCC or Calcitriol) regulates calcium levels in the bod
y (calcium homeostasis)
:Through
Increasing absorption of calcium by the intestine
Minimizing loss of calcium by kidney
Stimulating resorption of bone (when necessary)
 Calcitonin Hormone

: Calcitonin hormone is
Secreted by the parafollicular or “C” cells of the thyroid gland
Released in response to high blood calcium (hypercalcemia)
hypercalcemia

,In cases of hypercalcemia

: Calcitonin Hormone   blood [Ca2+] by
 Osteoclast activity (preventing release of calcium to blood)
 Renal reabsorption of calcium
Net result of its action   blood calcium

CALCITONIN IS THE ONLY HYPOCALCEMIC HORMONE

Calcium Regulation