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GEM > 3.02 Minerals > Flashcards

3.02 Minerals Flashcards

1
Q

What is the daily amount needed for macro minerals?

A

> 100 mg per day

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2
Q

Most abundant mineral in the body?

A

Calcium

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3
Q

Where is calcium in the body?

A

98% bone
The rest is free in cells (signal, muscle contraction, etc.)

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4
Q

What form does calcium need to be for absorption?

A

Ionized
(freed from slats)

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5
Q

Major sources of calcium in diet?

A

Dairy product, leafy greens, fortified orange juice (30-35% at a time)

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6
Q

Common causes of hypercalcemia?

A

Primary hyperparathyroidism
Cancer metastasis to bone
Vit D toxicity

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7
Q

Soft tissue calcification, EKG abnormalities, nausea, vomiting, anorexia can be clinical indication of?

A

Hypercalcemia

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8
Q

What happens when Ca2+ binds avidly to cell membrane phospholipids?

A

Reduces membrane fluidity

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9
Q

How many Ca2+ can bind to calmoduline to create the calcium-calmodulin complex?

A

4

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10
Q

When does Ca2+ become free/dissociated from salt it was bound to in order to be absorbed in intestine?

A

Low pH of stomach

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11
Q

What is the channel that uptakes the Ca2+ into the intestinal cell ?

A

TRPV5 < TRPV6*

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12
Q

What binds to the free Ca2+ immediately when it enters into an intestinal cell?

A

Calbindin-D

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13
Q

What BL proteins are responsible for pumping calcium into portal blood?

A

NCX1 - antiporter (Ca + 3Na+)
PMCA1b - active

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14
Q

How does Vitamin D increase Ca2+ absorption?

A

It promotes the activity and proliferation of calcium binding proteins, protein synthesis, and activating BL pumps

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15
Q

What is the unregulated way that ca2+ can go from the lumen to circulation (unable to be saturable)?

A

Paracellular transport

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16
Q

Where is the majority of calcium clearance?

A

Urine (free, 2%) and feces (most non absorbed)

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17
Q

What hormones tightly control serum levels of calcium?

A

PTH (Parathyroid hormone) and Vitamin D

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18
Q

How does PTH increase serum Ca2+ ?

A

increased bone resorption
Kidney calcium reabsorption

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19
Q

What does PTH do to serum phosphate?

A

It decreases it by reducing its absorption at the kidneys

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20
Q

What hormone is solely responsible for intestinal Ca2+ absorption?

A

Vit D

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21
Q

What reduces serum levels of calcium in the blood by inhibiting bone resorption and kidney reabsorption?

A

Calcitonin

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22
Q

What is calcitriol?

A

Active form of vitamin D

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23
Q

What does calcitriol do to promote increased serum calcium?

A

Increase bone resorption
Increase gut absorption
Increase kidney reabsorption

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24
Q

Where does the PTH act in order to increase serum calcium?

A

Bone and Kidney
(NO GUT INVOLVEMENT)

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25
Q

What are common causes of hypocalcemia?

A

Hypoparathyroidism
(Wilson’s Disease, thyroidectomy, primary PTH def, autoimmune)

Low Vit D
(Low sunlight, low diet, malabsorption diseases)

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26
Q

Bone density disorders (Rickets, osetomalacia, osteoporosis) and neuromuscular tetany, spasms, and cramping, cardiomyopathy (prolong QT), and laryngopharyngeal spams are indicative of?

A

Hypocalcemia

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27
Q

What is the most abundant intracellular ion in humans?

A

Phosphorus

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28
Q

Where is 85% of phosphorus in body found?

A

Bone and teeth (hydroxyapatite)

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29
Q

What the issue in drinking a lot of colas despite it being a good source of phosphorus?

A

It can form tight complexes with free calcium becoming insoluble and prevent both from being absorbed at gut

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30
Q

At physiologic pH, what is the form of free phosphate?

A

HPO4 2-
(Make it a good buffer)

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31
Q

What are the roles of phosphorus in our bodies?

A

Energy storage (ATP bonds)
Structural (phospholipids/nucleotides)
Metabolic charging
Protein modification and covalent regulation
Cell signaling
PH buffer

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32
Q

How is most of the phosphorus we need absorbed?

A

Diet as chylomicrons

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33
Q

How is free phosphate absorbed?

A

Na+/P symporter regulated by Vit D and estrogen

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34
Q

What are hormones that regulate serum phosphate?

A

Calcitriol - Increase
(bone + intestinal)

PTH - Decrease
(Kidney)

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35
Q

What are common causes of hypophospahatemia?

A

Vitamin D def
Antacid Aluminum overuse
Liver or kidney Dx
Malnutrition
Refeeding syndrome
Hyperparathyroidism
Chronic alcoholism
Fanconi Syndrome

36
Q

How can phosphorus depletion happen in Refeeding syndrome?

A

After long period of fasting/stravation the cells are flooded with carbs, insulin pushes glucose into cell, cells depletes phosphorus (cell then blood) to phosphorylate the glucose “sugar trap”

37
Q

Lethargy (CNS depression, irritability, seizures), anemia, and myopathy are common presentations of what?

A

Hypophosphatemia

38
Q

Common causes of hyperphosphatemia?

A

Decreased PTH production
Renal insufficiency - dehydration
Hyperlipidemia (impaired kidneys, insulin resistance, diet, inflamm)

39
Q

Tetany, diarrhea, soft tissue calcifications, and kidney stones are presentations of?

A

Hyperphosphatemia

40
Q

What should be noted about free iron, especially Fe2+?

A

Highly toxic b/c Fenton Reaction (free iron + hydrogen peroxide —> hydroxyl radical)

41
Q

Major sources of iron?

A

Diet
Heme = meat, poultry, shellfish
Ferric = cereals, lentils, molasses

42
Q

Major function of iron in body?

A

Oxygen transport
Cell respiration (Fe-S mito)
Drug & xenobiotic metabolism
Oxidative burst macrophages

43
Q

Key transport proteins for iron at enterocytes?

A

DMT-1 (free Fe2+)
Dcytb (Fe3+—> Fe2+)
HCP (heme)

44
Q

What oxidizes intracell Fe2+ (free) back to Fe3+ (ferretin)?

A

Heme oxygenase

45
Q

What happens to the remaining free iron inside a cell that is not stored in ferritin?

A

Ferroportin moves them out into circulation

46
Q

What happens when Fe2+ is released from enetrocyte into circulation?

A

Hephaeston (Heph) oxidizes Fe2+ —> Fe3+

Then Fe3+ able to bind to transferrin to move in blood to other organs

47
Q

Hormone secreted by liver that binds to ferroportin to internalize/destroy it in response to high serum iron levels?

A

Hepcidin

48
Q

Protein found in blood stream that oxidizes any free Fe2+ (ferrous) back to Fe3+ (ferric) ?

A

Ceruloplasmin

49
Q

What cofactor is necessary for ceruplasmin to do its job?

A

Copper

50
Q

What are factors that can inhibit iron absorption by acting as chelators?

A

Oxalates
Tannins
Polyphenols

51
Q

What allows infants to additionally absorb iron?

A

Lactoferrin mediated endocytosis (breast milk)
And Pinocytosis

52
Q

Main effect of iron deficiency?

A

Microcytic hypo chromic anemia
(Lethargy + neuro/physical delay)

53
Q

An overload of what can affect/inhibit iron absorption?

A

Excess Copper and Zinc absorption (competition)

54
Q

What is a downside to iron supplementation in terms of correcting the deficiency?

A

It can take week to months to correct

55
Q

What are signs of iron overload?

A

Nausea, headaches, neuroimpairment

56
Q

Hyperpigmentation with hyperglycemia and damage to the pancreas, liver, kidneys, and heart are signs of?

A

Hereditary hemochromatosis (iron overload)

57
Q

What is the most common cause of iron overload?

A

Over supplementation

58
Q

What is the role of copper in the body?

A

Required cofactor for ferroxidase enzymes in iron oxidation
Immune system signaling
Cell differentiation
Bone formation pathway
Oxidation defenses

59
Q

Although copper deficiency via diet is rare since it is in meat, shellfish, nut, and whole grains, the first sign of a deficiency is?

A

Anemia (iron metabolism impairment)

60
Q

What are the main copper transporters into enterocytes (entire length of small intestine)?

A

DMT1
Ctr1 (but needs Dcytb to reduce it to Cu1+ first)

61
Q

What copper transporter is seen in the BL?

A

ATP7A - Copper ATPase (active)

62
Q

How is copper transported in body?

A

Mostly through albumin
(But can also bind transferrin or ceruloplasmin)

63
Q

What is the main way that copper is excreted?

A

Biles salts allows it to be expelled from feces
(Also sloughed off intestinal cells)

64
Q

Copper and/or Zinc overload can cause iron deficiency because it displaces Fe3+ from what?

A

Transferrin

65
Q

Anemia, changes to hair, skeletal defects, and connective tissue disturbances, progressive neuro degeneration, altered pigmentation, nuetropenia are signs of?

A

Copper deficiency

66
Q

What are risk factors of copper deficiency?

A

MENKES SYNDROME
Diets rich in phytates/oxalates or low meat

67
Q

Where is the mutation in Menke’s Syndrome?

A

ATP7A

68
Q

Copper toxicity can lead to what?

A

Liver failure with chronic intakes >30mg/day
Most ADSE from iron absorption disruption

69
Q

What is the genetic deficiency of Wilsons disease?

A

ATP7B*

70
Q

What happens in Wilsons Disease?

A

Protein responsible for copper efflux (ATP7B) is shot, so it accumulates in liver, eyes, brain, kidneys, and skin

71
Q

What is a diagnostic test you can do for Wilsons Disease?

A

Urine Copper Levels (elevated)

72
Q

Why would urine copper be high in Wilsons disease?

A

Liver damage to hepatocytes causes them to burst and spill into circulation

73
Q

Cognitive impairment, loss of motor function, and liver failure are signs of?

A

Copper toxicity

74
Q

Treatments for copper toxicity?

A

Zinc supplementation and chelation

75
Q

Roles of zinc in the body?

A

Structure of transcription factors (Zinc fingers) = gene expression
Insulin store/secrete
Immune signaling and diff
Cofactors (LOTS)

76
Q

Zinc dependent hormone involved in T cell differentiation?

A

Thymulin

77
Q

Sources of ZInc in diet?

A

Meat, fish, eggs, diary

78
Q

Who should consider Zinc supplementation?

A

Strict vegans

79
Q

What protein is for zinc uptake into enterocyte?

A

ZIP4

80
Q

What proteins allow zinc to move from enterocyte into circulation?

A

ZIP5 or ZnT1

81
Q

How does zinc mostly move through the body?

A

Bound to albumin

82
Q

How is zinc mostly excreted?

A

Feces (bile salts + metallothionien)

83
Q

Appetite loss, alopecia, hyperkeratinization of skin, slow growth in children, low T/B cells, loss of taste and smell, low sperm count are signs of?

A

Zinc deficiency

84
Q

What are some risk factors of zinc deficiency?

A

Phytate rich food
Low meat diets
Metal chelating drugs
Acrodermatitis enteropathica (defined of SLC39A4 - encodes ZIP4)
Vision problems

85
Q

Most common cause of zinc toxicity?

A

Excess long term supplementation, excess cold Lozenges, and Neutropenia (secondary to Cu def)

GEM (28 decks)

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