FUNCTIONS

OF
CALCIUM
 Amount of calcium absorbed
from the GIT

Parathyroid hormone
 Like increasing intestinal absorption of
calcium, also mobilizes bone calcium and
causes marked hypercalcemia.

 It also increases calcium absorption from the

distal convoluted tubules of the kidney.
 Inverse relationship between plasma
calcium and inorganic phosphate
(Pi) level
 When plasma calcium rises, the plasma inorganic
phosphorus level falls and vice versa.

 The product of plasma calcium and inorganic

phosphorus (both in mg/dl) remains constant at
30 to 40 in the adult and 40 to 55 in children.

1
 Plasma calcium level falls in kidney diseases due
to retention of phosphate, which leads to a high
plasma Pi level and hypocalcemia.

 The other contributory factor is non-activation of

vitamin D.

 The hypocalcemia leads to secondary hyper

parathyroidism .
 Plasma protein level
Each gram of plasma/serum protein binds 0.84

mg of calcium. Thus a decrease in serum protein

level (i.e. hypoproteinemia) will result in a

decreased level of bound calcium and will also

result in a lowered total serum calcium.

 Plasma protein level

As the ionized serum calcium

remains normal, therefore such a

person will not suffer tetany because

it is only the ionized calcium which is

physiologically active.
 Renal excretion

 Normally only a small part of calcium lost from

the body is excreted in urine.

 If excessive amount of calcium is administered,

more Na+ is being excreted in urine,

 Renal loss of calcium is also increased if more

Na+ is being excreted e.g. by diuretics.
 Calcitonin

 Produced by the para follicular cells (clear or C cells)

of the thyroid gland.

 It lowers the plasma Ca++ level, (it antagonizes the

action of PTH )

 It decreases bone re-sorption and increases the

deposition of Ca++ in bones.

 It increases urinary loss of Ca ++ by inhibiting the

Ca++ re-absorption in the proximal convoluted
tubules.
FUNCTIONS OF CALCIUM
 1- Function
 Calcium salts take part in bone and tooth
development .

 Deficient supply of calcium leads to rickets in

children and osteomalacia in adults.

 Sufficient calcium intake must be ensured in

early life to buildup the skeletal reserves.
 If this is not done

then there occurs an increased incidence of

osteoporosis in old age because at that time

deficiency of sex hormones especially in females

results in calcium mobilization from bones

leading to osteoporosis
 2- Function
The clotting of blood needs calcium ions.
 Calcium is known as factor iv in blood
coagulation cascade.

 Prothrombin contains gamma carboxyl glutamate

residue which are chelated by calcium during the
thrombin formation.

 3-Function
 By regulating the membrane permeability Ca++
control the excitability of nerves.
 If plasma Ca++ level falls markedly, tetany
results in which spasms of various muscle
groups occur.
 Death may occur from convulsions or from
laryngospasm.
 Excess of plasma Ca++ depresses nervous
activity.
 4-Function

Calcium ions act as a cofactor or

activator of certain enzymes.

A protein namely calmodulin is present

within cells which can bind calcium.
 calmodulin-calcium complex
Becomes attached to certain enzymes which
are activated.
Such enzymes include adenylate cyclase. Ca++
ATPase phosphorylase kinase, myosin light
chain kinase, phosphodi-esterase and
phospholipase A 2.
This mechanism is also required for the
release of acetylcholine at the neuro-
muscular junctions.
 5-Functions
 Calcium ions take part in the contraction of

muscle including heart muscle and are involved

in the excitation- contraction coupling

mechanism. With an increased plasma calcium,

heart stops in systole (calcium rigor)

 In addition
 a high plasma calcium decreases conduction of

cardiac impulses and thus can produce heart

block.

 Calcium ions potentiate the effects of cardiac

glycosides and therefore should not be given

to patients who are using these drugs.

 Functions
 Calcium ions are responsible for initiating
contraction in vascular and other smooth
muscles. Calcium ions enter through specific
channels just as is the case with cardiac muscle.
Drugs which block these channel (Ca++ channel
blockers) have profound effect on the
contractility of cardiac and smooth muscles as
well as on the conduction of impulses within the
heart. These drugs find use in treatment angina
pectoris, cardiac arrhythmias and hypertension.
 6-Functions

 Calcium is essential for maintaining the

integrity of capillary wall. in its deficiency,
capillary walls become fragile and there is
increased permeability of capillaries .In a similar
manner it has a role maintaining the integrity of
mucosal membranes and cell adhesion.
 7-Function

 Calcium ions are involved in exocytosis and thus

have an important role in stimuls-secretion
coupling in most exocrine and endocrine glands
e.g the release of catecholamines from the
adrenal medulla, and histamine from mast cell is
dependent upon Ca++ .
 Some hormones

exert their influence through Ca++ . For

example, the effect of adrenaline on the liver

cells to increase glycogenolysis is partly due to

an increased Ca++ within these cells.

 Resent studies
- Calcium may play a substantial
contributing role in reducing the
incidence of obesity and prevalence
of the insulin resistance syndrome
 Resent studies
High calcium intake is associated
with a plasma lipoprotein-lipid
profile predictive of a lower risk of
coronary heart disease compared
with a low calcium intake
 Resent studies
Dairy product intake (with recommended
calcium levels) protect women consuming
oral contraceptives from spine and hip
bone loss

Children who avoid drinking cow milk have

low dietary calcium intakes and poor bone
health
 Toxicity of calcium
 Excessive intake of calcium can be dangerous

because calcium gets deposited in various body

tissues resulting in their mal-functioning .

 This effect of hypercalcemia is seen more

frequently if serum Pi level is normal or raised.

 Calcium excretion
 Daily 1240 mg calcium enters the gut, 1000 mg
from food and 240 mg from the blood; of this
480 mg is absorbed showing a net absorption
of 240 mg.

 Feces eliminate 760 mg calcium day which

represents the unabsorbed dietary calcium
along with calcium coming from the blood.
 Calcium excretion

 Of the 6000 mg calcium filtered by the glomeruli

most of it is reabsorbed and the kidneys excrete

only 240 mg calcium /day which represents the

real excretion of calcium from the body.

 Calcium excretion

 Normally only a negligible amount is lost from

the skin but excessive sweating result in an

appreciable loss of body calcium.

 Calcium excretion

 Pregnancy and lactation result in a significant

loss of mother’s calcium

 Calcium balance

 It is the difference between the quantity of

calcium ingested and lost from the body over a
certain period of time. If the quantity of calcium
lost from the body is less than that ingested, the
balance in called positive. If more calcium is
lost than ingested, it is called a negative calcium
balance.
 Conditions associated with a positive
calcium balance.

1. Growth

2. Hyperpituitarism involving growth hormone

3.Pregnancy and lactation

4.Calcium intake after a long period of calcium

deprivation
 Conditions associated with a negative
calcium balance.

1.Rickets and osteomalacia

2. Hyperparathyroidism
3. Malabsorption
4. Hyperthyroidism
5. Starvation
6. Decreased calcium intake
7. Deficiency of sex hormones in both sexes
(eg .old age)
Absorption increased by: Absorption decreased by:

 Vitamin D deficiency
 Body need  Cal-phos imbalance
 Vitamin D  Oxalic acid
 Phosphorous
 PTH  Dietary fiber
 Protein  Excessive fat
 Lactose  High alkalinity
 Stresses and
 Acid medium  Lack of exercise
Excretion increased by Excretion decreased by

 High PTH
 Low PTH  Low ECF Vol
 High ECF Vol.  Low BP
 High BP  High plasma PO=4
 Low plasma PO=4  Metabolic acidosis
 Metabolic alkalosis  Vitamin D3
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