MineralsMineralsAccording to the body needs, minerals are divided into 2 groups:According to the body needs, minerals are divided into 2 groups:

I. Macrominerals:I. Macrominerals:

They are required in amounts less than 100 mg/day. They They are required in amounts less than 100 mg/day. They

include: iron, copper, fluoride, iodine, manganese, include: iron, copper, fluoride, iodine, manganese,

selenium and zinc.selenium and zinc.

They are required in amounts greater than 100 mg/day. They are required in amounts greater than 100 mg/day.

They include: calcium, phosphorus, magnesium, sodium, They include: calcium, phosphorus, magnesium, sodium,

potassium and chloridepotassium and chloride

II. Microminerals (trace elements):II. Microminerals (trace elements):

I.I. MacromineralsMacromineralsCalciumCalcium

Sources:Sources:

Milk, milk products, beans and egg yolk.Milk, milk products, beans and egg yolk.

Absorption:Absorption:

By active transport system in the upper small intestine by theBy active transport system in the upper small intestine by the

help of vitamin D (1,25 dihydroxy cholicalciferol).help of vitamin D (1,25 dihydroxy cholicalciferol).

Body calcium:Body calcium:

calcium is the most abundant mineral in the body. Most ofcalcium is the most abundant mineral in the body. Most of

calcium (99%) is present in the skeleton (bones and teeth),calcium (99%) is present in the skeleton (bones and teeth),

the remaining 1% are present in body fluids and other tissuesthe remaining 1% are present in body fluids and other tissues

Plasma calcium:Plasma calcium:

normal level ranges from 9-11 mg/dlnormal level ranges from 9-11 mg/dl

Hormonal regulation of Plasma calcium:Hormonal regulation of Plasma calcium:

1. Calcitonin: 1. Calcitonin: is secreted from thyroid gland in response to increasedis secreted from thyroid gland in response to increasedblood Ca level. It decreases Ca through:blood Ca level. It decreases Ca through:

A.A. Mobilization of calcium from blood into boneMobilization of calcium from blood into boneB.B. Decrease Ca reabsorption by renal tubules Decrease Ca reabsorption by renal tubules

2. Parathyroid hormone (PTH): 2. Parathyroid hormone (PTH): secreted from parathyroid gland insecreted from parathyroid gland in

response to decreased calcium levels. It increase calcium by:response to decreased calcium levels. It increase calcium by:

A.A. Mobilization of calcium from bone to blood (bone Mobilization of calcium from bone to blood (bone resorption)resorption)

B.B. Increases Ca reabsorption by renal tubulesIncreases Ca reabsorption by renal tubulesC.C. Increase absorption of calcium from small intestine Increase absorption of calcium from small intestine

through stimulation of vitamin D activation.through stimulation of vitamin D activation.

HypercacemiaHypercacemia: : may be due to:may be due to:

1.1. Hyperparethyrodism due to adenoma ( benign tumor of the gland)Hyperparethyrodism due to adenoma ( benign tumor of the gland)2.2. Excess intake of vitamin D or calciumExcess intake of vitamin D or calcium3.3. Milk-alkali syndrome : patients who receive milk and alkalies for long Milk-alkali syndrome : patients who receive milk and alkalies for long

time, for treatment of peptic ulcertime, for treatment of peptic ulcer4.4. Drugs such as thiazide diureticsDrugs such as thiazide diuretics

Hypocacemia:Hypocacemia: due to: due to:

1.1. HypoparathyrodismHypoparathyrodism2.2. Renal disease where activation of vitamin D is inhibitedRenal disease where activation of vitamin D is inhibited

Requirments: Requirments:

1.1. AdultAdult: 800 mg/day: 800 mg/day2.2. Children, pregnant and lactating womenChildren, pregnant and lactating women: 800-1200 mg/day: 800-1200 mg/day

SodiumSodium Sources:Sources:

The main source is table saltThe main source is table salt Absorption:Absorption:

from small intestine (ileum). It is nearly completely absorbed.from small intestine (ileum). It is nearly completely absorbed.Body sodium:Body sodium:

2/3 of sodium is present in tissues and body fluids. About 1/3 is2/3 of sodium is present in tissues and body fluids. About 1/3 is present in skeleton (bone and teeth) present in skeleton (bone and teeth)

Requirements:Requirements: 5 g/day 5 g/dayAlterations of plasma sodium:Alterations of plasma sodium:HypernatremiaHypernatremia: : excess plasma sodium is caused by:excess plasma sodium is caused by:

1.1. Cushing syndrome. Cushing syndrome. 2.2. Conn's disease due to excessive aldosterone secretionConn's disease due to excessive aldosterone secretion3.3. Diabetes inspidus due to rapid loss of waterDiabetes inspidus due to rapid loss of water4.4. Drugs such as cortisoneDrugs such as cortisone

Hyponatremia: Hyponatremia: decrease plasma sodium caused by:decrease plasma sodium caused by:1.1. Addison's disease: due to deficiency of aldosteroneAddison's disease: due to deficiency of aldosterone2.2. Renal failure where renal reabsorption of sodium is inhibitedRenal failure where renal reabsorption of sodium is inhibited3.3. Dehydration: due to loss of water and sodiumDehydration: due to loss of water and sodium4.4. Thaizide diuretics which block renal reabsorption of sodium Thaizide diuretics which block renal reabsorption of sodium

Toxicity of sodium: Toxicity of sodium: Hypertension in susceptible individuals.Hypertension in susceptible individuals.

PotassiumPotassiumSources: Sources:

vegetables, fruits and nutsvegetables, fruits and nuts

Absorption: Absorption: Readily occur from small intestine Readily occur from small intestine

Body sodium: Body sodium: 2/3 of potassium is present in tissues and body fluids. About 1/32/3 of potassium is present in tissues and body fluids. About 1/3

is present in skeleton (bone and teeth)is present in skeleton (bone and teeth)Requirements: Requirements: 4 g/day4 g/day

Alterations of plasma sodium:Alterations of plasma sodium:

Hyperkalemia:Hyperkalemia: excess plasma potassium is caused by: excess plasma potassium is caused by:

1.1. Addison's disease: due to deficiency of aldosteroneAddison's disease: due to deficiency of aldosterone2.2. Acidosis Acidosis 3.3. Tissue necrosis e.g. major trauma and burns due to leakage of tissue Tissue necrosis e.g. major trauma and burns due to leakage of tissue

potassiumpotassium4.4. Chronic renal failure with oliguriaChronic renal failure with oliguria5.5. Uncontrolled D. M. Lack of insulin prevent potassium from rntering Uncontrolled D. M. Lack of insulin prevent potassium from rntering

cellscells

1.1. alkalosisalkalosis2.2. treatment of hyperglycemia with insulin without taking potassium, as treatment of hyperglycemia with insulin without taking potassium, as

insulin helps potassium ion to enter cellsinsulin helps potassium ion to enter cells3.3. Excessive vomiting and diarrheaExcessive vomiting and diarrhea4.4. Cushing syndromeCushing syndrome5.5. DiureticsDiuretics

Hypokalemia: Hypokalemia: decrease plasma potassium caused by:decrease plasma potassium caused by:

Microminerals (Trace elements)Microminerals (Trace elements)IRONIRON

Sources: Sources: Liver, heart, kidney, spleen, and fishLiver, heart, kidney, spleen, and fish

Sugarcane syrup (molasses), dates and egg yolkSugarcane syrup (molasses), dates and egg yolk

N.B. Most of dietary iron is present in the ferric stae.N.B. Most of dietary iron is present in the ferric stae.

Absorption: Absorption: from small intestine. Usually 10-20% of dietary iron isfrom small intestine. Usually 10-20% of dietary iron is

only absorbed. Iron is absorbed in ferrous state. only absorbed. Iron is absorbed in ferrous state.

Reducing substances such as vitamin C and SH- of cysteineReducing substances such as vitamin C and SH- of cysteine

of dietary protein help the reducing of ferric ions into the of dietary protein help the reducing of ferric ions into the

absorbable form (ferrous state).absorbable form (ferrous state).

Body iron: Body iron: The total body iron of adult is 3-5 g distributed as follows:The total body iron of adult is 3-5 g distributed as follows:

I -RBCs iron ( haemoglobin) is about 65% of total ironI -RBCs iron ( haemoglobin) is about 65% of total ironII- Tissue iron (32%): includes II- Tissue iron (32%): includes

Available forms (28%) Available forms (28%) i.e. can be used when there body needi.e. can be used when there body need1-Ferritin : 1-Ferritin : is the main storage form of iron. Composed of protein (apoferritin is the main storage form of iron. Composed of protein (apoferritin

+ iron). Present in iron stores: liver, spleen, bone marrow and + iron). Present in iron stores: liver, spleen, bone marrow and intestine.intestine.

2- Haemosiderin: 2- Haemosiderin: These are granules composed of iron, protein and These are granules composed of iron, protein and polysaccharides. Used as another store of ironpolysaccharides. Used as another store of iron

III- Plasma iron: present in the form of:III- Plasma iron: present in the form of:1-plasma iron : ranges from 60- 160 μg/ dl1-plasma iron : ranges from 60- 160 μg/ dl 2- Transferrin : is a glycoprotein which carry iron in ferric state. 2- Transferrin : is a glycoprotein which carry iron in ferric state.

Non available forms (4%): Non available forms (4%): can not be used even there is body need. All these can not be used even there is body need. All these

forms are hemoprotein i.e. contain heme ring. Examples are:forms are hemoprotein i.e. contain heme ring. Examples are:

1.1. Myoglobin:Myoglobin: present in muscle and heart present in muscle and heart

2.2. Cytochromes:Cytochromes: a, b and c: act as electron carriers a, b and c: act as electron carriers

3.3. CCaatalase and peroxidasetalase and peroxidase: act to destroy H: act to destroy H22OO22

Transport and storage of iron:Transport and storage of iron:

1.1. Absorbed iron enters in the portal blood in the ferrous state.Absorbed iron enters in the portal blood in the ferrous state.

2.2. In the plama it is rapidly oxidized to ferric state by the help of protein- In the plama it is rapidly oxidized to ferric state by the help of protein-

containing copper called: Ceruloplasmincontaining copper called: Ceruloplasmin

3.3. Then ferric ions are carried by transferring, which is\taken mostly by Then ferric ions are carried by transferring, which is\taken mostly by

bone marrow to synthesize hemoglobinbone marrow to synthesize hemoglobin

4.4. Iron from iron stores (ferritin) can be released into plasma and carried Iron from iron stores (ferritin) can be released into plasma and carried

by transferring to be used by B.M. and other tissuesby transferring to be used by B.M. and other tissues

Requirements: Requirements:

1.1. adults: adults: 10 mg/day10 mg/day

2.2. Pregnant and lactating female:Pregnant and lactating female: 30 mg/day 30 mg/day

CopperCopperSourcesSources : : Most diet provides the amount of copper needed per day.Most diet provides the amount of copper needed per day.

AbsorptionAbsorption : : Mainly in the upper small intestine Mainly in the upper small intestine

Body copperBody copper : : 64% of copper are found in muscles and the remaining in64% of copper are found in muscles and the remaining in

other tissues including liver and bones. other tissues including liver and bones.

Plasma copper : Plasma copper : 90 μg/ dl. 90 μg/ dl.

Copper is essential component of several metaloenzymes such as:Copper is essential component of several metaloenzymes such as:

1.1. Ceruloplasmin: Ceruloplasmin: which oxidizes ferrous into ferric in plasmawhich oxidizes ferrous into ferric in plasma2.2. Superoxide desmutae: Superoxide desmutae: antioxidant enzymeantioxidant enzyme3.3. Cytochrome oxidaseCytochrome oxidase

Requirements:Requirements: 2-3 mg/day2-3 mg/day

Alterations of plasma copper:Alterations of plasma copper:Hyper cupremiaHyper cupremia (Excess copper and ceruloplasmin) occur in infections (Excess copper and ceruloplasmin) occur in infections

and malignanciesand malignancies

Hypocupremia (decreased plasma copper):Hypocupremia (decreased plasma copper): occure in a disease called occure in a disease called Wilson's disease in which copper accumulate in large amounts in:Wilson's disease in which copper accumulate in large amounts in:

1.1. Liver causing liver cirrhosisLiver causing liver cirrhosis

2.2. cornea causing greenish- brown color of the corneal marginecornea causing greenish- brown color of the corneal margine

Kidney causing damage of renal tubules leading to increased excretion of Kidney causing damage of renal tubules leading to increased excretion of

copper and ceruloplasmin resulting in low plasma copper.copper and ceruloplasmin resulting in low plasma copper.

IodineIodineThe only function is formation of T3 and T4 from thyroid gland, so deficiency The only function is formation of T3 and T4 from thyroid gland, so deficiency

of iodine leading to hypothyroidism and disease called Simple Goiter.of iodine leading to hypothyroidism and disease called Simple Goiter.

Requirements:Requirements: 100-150 μg/day 100-150 μg/day

Zinc, Selenium, fluoride and cobaltZinc, Selenium, fluoride and cobalt