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GI Skildum > Minerals (1.16) > Flashcards

Minerals (1.16) Flashcards

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1
Q

What is the most abundant mineral in the body?

A

Calcium

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2
Q

What functions does calcium serve?

A 
Bone mineralization
Blood clotting
Muscle contraction
Metabolism regulator
Secondary messenger
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3
Q

What regulates calcium absorption?

A

PTH –> Vitamin D (calcitriol) –> tsl of proteins
Calcineurin –> inhibits calcium channels
Calcium/calmodulin kinase –> Inhibits glycogen synthase

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4
Q

What increases calcium absorption?

A

Vitamin D
Sugar/Sugar alcohols
Protein

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5
Q

What decreases calcium absorption?

A

Fiber
Phytic, oxalic acids
Other divalent cations
Unabsorbed fatty acids

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6
Q

How does calcium usually travel in the blood? What is the second most likely form?

A

Calcium is mostly in free ionized form in the blood

Significant amount also travels bound to protein (albumin)

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7
Q

What effect does calcium have on phosphorus and iron uptake?

A

Calcium blocks phosphorus and iron uptake

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8
Q

What does calcium do to fatty acids and bile salts?

A

Calcium traps fatty acids and bile salts in a non-digestible soap

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9
Q

How is calcium excreted?

A

Urine
Feces
Sweat

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10
Q

What controls calcium reabsorption in the proximal tubule? What can effect calcium reabsorption?

A

Calcitriol controls calcium reabsorption

Caffeine increases calcium excretion
Increased sodium increases calcium excretion

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11
Q

Who is at risk for calcium deficiency?

A 
Patients with fat malabsorption disorders
Immobilized patients (bone calcium stores deplete)
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12
Q

What can calcium deficiency cause?

A

Rickets
Tetany
Osteoporosis

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13
Q

What is calcium deficiency associated with?

A

Colorectal cancer
HTN
DMII

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14
Q

What is the best method of determining if a patient has calcium deficiency?

A

Bone density scan

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15
Q

What are the symptoms of acute calcium toxicity?

A

Constipation

Bloating

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16
Q

What are the symptoms of chronic calcium toxicity?

A

Calcification of soft tissue
Hyperaclciuria
Kidney stones

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17
Q

What is the second most abundant mineral in the body?

A

Phosphorus

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18
Q

Where is the majority of the phosphorus in the body?

A

Bone

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19
Q

How is phosphorus usually absorbed? What form is phosphorus in?

A

Diffusion in proximal duodenum

H2PO4-

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20
Q

How can phosphorus be absorbed if intake is low?

A

Calcitriol activates a saturable carrier mediated active transporter

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21
Q

What inhibits phosphorus absorption? What does this mean for treating hyperphosphatemia?

A

Magnesium
Aluminum
Calcium

Antacids can be used to treat hyperphosphatemia from kidney failure

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22
Q

What functions does phosphorus serve?

A

Bone mineralization
High energy bonds
Acid/base tolerance
Availability of oxygen (2,3-BPG)

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23
Q

What promotes phosphorus excretion?

A

Elevated dietary phosphorus
PTH
Acidosis
Phosphotonins–from osteoblasts and osteocytes

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24
Q

What inhibits excretion of phosphorus?

A 
Low dietary phosphorus
Calcitriol
Alkalosis
Estrogen
Thyroid hormone
Growth hormone
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25
What are some external causes of phosphorus deficiency?
Extreme antacid use Malnourishment Refeeding syndrome
26
What are some inherited disorders that cause phosphorus deficiency?
Dents Disease X-linked Hypophosphatemic Rickets Autosomal dominant Hypophosphatemic Rickets
27
What is Dents Disease?
X-linked | Mutation in renal Chloride channel
28
What is X-linked Hypophosphatemic Rickets?
Mutation of PHEX gene --> elevated FGF-23
29
What is Autosomal dominant Hypophosphatemic Rickets?
Mutation in the gene encoding FGF-23 gene...prevents its degradation
30
What are the symptoms of phosphorus deficiency?
``` Anorexia Reduced cardiac output Decreased diaphragmatic contractility Myopathy Death ```
31
What is the third most abundant mineral in the body?
Potassium
32
How is potassium absorbed?
Paracellular diffusion K/H ATPase Basolateral K+ channel
33
What functions do potassium serve?
Electrical membrane potential | Muscle contractility
34
How is potassium regulated?
Vasopressin and aldosterone increase urinary K+ excretion...opposite of Na+
35
What does potassium do to calcium excretion?
K+ decreases Ca++ excretion...opposite of Na+
36
What are some functions of chloride?
``` Chloride/Bicarb exchanger (RBC, intestinal, etc.) Hypochlorous acid (secreted by neutrophils during phagocytosis to neutralize pathogens) ```
37
What can cause chloride deficiency?
Fluid loss Thiazide or loop diuretics Refeeding syndrome
38
What are the symptoms of potassium deficiency?
``` Cardiac arrhythmias Muscle weakness Hypercalciuria Glucose intolerance Mental disorientation ```
39
What happens with moderate potassium deficiency?
Elevated blood pressure | Decreased bone density (increased urinary calcium excretion)
40
What can cause hyperkalemia? What can hyperkalemia cause?
Renal failure can lead to hyperkalemia Hyperkalemia can lead to cardiac arrhythmia/arrest
41
What foods have magnesium?
``` Nuts Legumes Whole grains Chlorophyll Chocolate 'Hard' water ```
42
How is magnesium transported into the blood?
Through a magnesium channel (TRPM6) | Out a Mg/Na ATPase
43
What form of magnesium is highest in the blood?
Free --> protein bound --> salt
44
What are some interactions magnesium has on other dietary substances?
Mimics calcium --> competes for reabsorption in the kidney Inhibits phosphorus absorption by forming a precipitate
45
What is the best measurement of magnesium level?
Renal Mg excretion before and after a loading dose Erythrocyte magnesium isn't a horrible measure
46
What are some causes of magnesium deficiency?
Gitelman Syndrome
47
What is Gitelman Syndrome?
Autosomal recessive mutation --> thiazide sensitive Na/Cl
48
Besides hypomagnesemia, what else does Gitelman Syndrome cause?
Hypokalemia | Hypocalciuria
49
What are the symptoms of magnesium toxicity?
``` Diarrhea Dehydration Flushing Slurred speech Muscle weakness Loss of deep tendon reflex Cardiac arrest...[Mg] > 15mg/dL ```
50
What is associated with magnesium toxicity?
Epsom salt
51
How does iron enter the intestinal epithelium?
Fe(3+) --reductase-->Fe(2+) | Fe(2+) --DMT1--> into cell
52
How does iron leave the intestinal cell?
Fe(2+) --ceruloplasmin-->Fe(3+) | Fe(3+) --ferroportin--> plasma (transferritin)
53
What are the functions of iron?
Heme synthesis Iron-sulfur clusters (electron transfer group) Dioxygenase
54
What are some interactions iron has with other dietary stuffs?
Vitamin C enhances absorption and maintains iron in reduced state Copper (required for ceruloplasmin) Iron inhibits zinc absorption
55
Who occasionally has iron deficiency?
Infants (low iron diets) Adolescents (rapid growth rate) Pregnant (rapid growth rate; blood loss at delivery) Absorption disorders
56
What are the symptoms of iron deficiency?
Microcytic hypochromic anemia Listlessness Fatigue
57
What foods have copper?
Meat Shellfish Nuts
58
How is copper transported to the blood?
Cu(2+) --reductase--> Cu(+) Cu(+) --CTR1--> enterocyte Enterocyte --ATP7A--> blood (bound to proteins)
59
What is a mutation that effects copper transport?
Menkes kinky hair syndrome
60
What is seen with Menkes kinky hair syndrome?
``` Hypothermia Hypotonia Poor feeding Failure to thrive Seizures Normal hair at birth --> becomes brittle/sparse ```
61
What are the functions of copper?
Cofactor for ceruloplasmin Cytochrome C oxidase has 3 Cu+/enzyme Cofactor for lysyl oxidase (collagen synthesis...also requires ascorbate) Superoxide dismutase (antioxidant enzyme) Dopamine beta-hydroxylase (catecholamine synthesis)
62
What causes copper deficiency?
Too much zinc | A lot of PPIs
63
What are the symptoms of copper deficiency?
Anemia Leukopenia Hypopigmentation of skin/hair Altered cholesterol metabolism
64
What are the acute symptoms of copper toxicity?
Epigastric pain N/V Diarrhea
65
What are the chronic symptoms of copper toxicity?
Hematuria Liver damage Kidney damage
66
What is Wilson Disease?
Mutation in liver specific copper transporter ATP7A
67
What is the effect of Wilson Disease?
Cannot transport excess copper into bile --> copper accumulates
68
What can be seen in the eyes of a person with Wilson Disease?
Kayser-Fleischer ring
69
What are the treatment options for Wilson Disease?
Avoid high copper foods | Chelation therapy

GI Skildum (8 decks)

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