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GI Skildum > Minerals (1.16) > Flashcards

Minerals (1.16) Flashcards

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
Q

What are some external causes of phosphorus deficiency?

A

Extreme antacid use
Malnourishment
Refeeding syndrome

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26
Q

What are some inherited disorders that cause phosphorus deficiency?

A

Dents Disease
X-linked Hypophosphatemic Rickets
Autosomal dominant Hypophosphatemic Rickets

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27
Q

What is Dents Disease?

A

X-linked

Mutation in renal Chloride channel

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28
Q

What is X-linked Hypophosphatemic Rickets?

A

Mutation of PHEX gene –> elevated FGF-23

29
Q

What is Autosomal dominant Hypophosphatemic Rickets?

A

Mutation in the gene encoding FGF-23 gene…prevents its degradation

30
Q

What are the symptoms of phosphorus deficiency?

A 
Anorexia
Reduced cardiac output
Decreased diaphragmatic contractility
Myopathy
Death
31
Q

What is the third most abundant mineral in the body?

A

Potassium

32
Q

How is potassium absorbed?

A

Paracellular diffusion
K/H ATPase
Basolateral K+ channel

33
Q

What functions do potassium serve?

A

Electrical membrane potential

Muscle contractility

34
Q

How is potassium regulated?

A

Vasopressin and aldosterone increase urinary K+ excretion…opposite of Na+

35
Q

What does potassium do to calcium excretion?

A

K+ decreases Ca++ excretion…opposite of Na+

36
Q

What are some functions of chloride?

A 
Chloride/Bicarb exchanger (RBC, intestinal, etc.)
Hypochlorous acid (secreted by neutrophils during phagocytosis to neutralize pathogens)
37
Q

What can cause chloride deficiency?

A

Fluid loss
Thiazide or loop diuretics
Refeeding syndrome

38
Q

What are the symptoms of potassium deficiency?

A 
Cardiac arrhythmias
Muscle weakness
Hypercalciuria
Glucose intolerance
Mental disorientation
39
Q

What happens with moderate potassium deficiency?

A

Elevated blood pressure

Decreased bone density (increased urinary calcium excretion)

40
Q

What can cause hyperkalemia? What can hyperkalemia cause?

A

Renal failure can lead to hyperkalemia

Hyperkalemia can lead to cardiac arrhythmia/arrest

41
Q

What foods have magnesium?

A 
Nuts
Legumes
Whole grains
Chlorophyll
Chocolate
'Hard' water
42
Q

How is magnesium transported into the blood?

A

Through a magnesium channel (TRPM6)

Out a Mg/Na ATPase

43
Q

What form of magnesium is highest in the blood?

A

Free –> protein bound –> salt

44
Q

What are some interactions magnesium has on other dietary substances?

A

Mimics calcium –> competes for reabsorption in the kidney

Inhibits phosphorus absorption by forming a precipitate

45
Q

What is the best measurement of magnesium level?

A

Renal Mg excretion before and after a loading dose

Erythrocyte magnesium isn’t a horrible measure

46
Q

What are some causes of magnesium deficiency?

A

Gitelman Syndrome

47
Q

What is Gitelman Syndrome?

A

Autosomal recessive mutation –> thiazide sensitive Na/Cl

48
Q

Besides hypomagnesemia, what else does Gitelman Syndrome cause?

A

Hypokalemia

Hypocalciuria

49
Q

What are the symptoms of magnesium toxicity?

A 
Diarrhea
Dehydration
Flushing
Slurred speech
Muscle weakness
Loss of deep tendon reflex
Cardiac arrest...[Mg] > 15mg/dL
50
Q

What is associated with magnesium toxicity?

A

Epsom salt

51
Q

How does iron enter the intestinal epithelium?

A

Fe(3+) –reductase–>Fe(2+)

Fe(2+) –DMT1–> into cell

52
Q

How does iron leave the intestinal cell?

A

Fe(2+) –ceruloplasmin–>Fe(3+)

Fe(3+) –ferroportin–> plasma (transferritin)

53
Q

What are the functions of iron?

A

Heme synthesis
Iron-sulfur clusters (electron transfer group)
Dioxygenase

54
Q

What are some interactions iron has with other dietary stuffs?

A

Vitamin C enhances absorption and maintains iron in reduced state
Copper (required for ceruloplasmin)
Iron inhibits zinc absorption

55
Q

Who occasionally has iron deficiency?

A

Infants (low iron diets)
Adolescents (rapid growth rate)
Pregnant (rapid growth rate; blood loss at delivery)
Absorption disorders

56
Q

What are the symptoms of iron deficiency?

A

Microcytic hypochromic anemia
Listlessness
Fatigue

57
Q

What foods have copper?

A

Meat
Shellfish
Nuts

58
Q

How is copper transported to the blood?

A

Cu(2+) –reductase–> Cu(+)
Cu(+) –CTR1–> enterocyte
Enterocyte –ATP7A–> blood (bound to proteins)

59
Q

What is a mutation that effects copper transport?

A

Menkes kinky hair syndrome

60
Q

What is seen with Menkes kinky hair syndrome?

A 
Hypothermia
Hypotonia
Poor feeding
Failure to thrive
Seizures
Normal hair at birth --> becomes brittle/sparse
61
Q

What are the functions of copper?

A

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
Q

What causes copper deficiency?

A

Too much zinc

A lot of PPIs

63
Q

What are the symptoms of copper deficiency?

A

Anemia
Leukopenia
Hypopigmentation of skin/hair
Altered cholesterol metabolism

64
Q

What are the acute symptoms of copper toxicity?

A

Epigastric pain
N/V
Diarrhea

65
Q

What are the chronic symptoms of copper toxicity?

A

Hematuria
Liver damage
Kidney damage

66
Q

What is Wilson Disease?

A

Mutation in liver specific copper transporter ATP7A

67
Q

What is the effect of Wilson Disease?

A

Cannot transport excess copper into bile –> copper accumulates

68
Q

What can be seen in the eyes of a person with Wilson Disease?

A

Kayser-Fleischer ring

69
Q

What are the treatment options for Wilson Disease?

A

Avoid high copper foods

Chelation therapy

GI Skildum (8 decks)

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