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5/22/2017 1 5/22/2017 2 Inorganic elements or salts Bind with enzymes or other organic molecules Help to regulate many body functions Building blocks for many body structures Required for intracellular and extracellular body fluid electrolytes Macrominerals Microminerals, or trace elements 5/22/2017 3 Most abundant mineral element in the body Accounts for 2% of body weight Highest concentration in bones and teeth Efficient absorption requires adequate amounts of vitamin D Found in many foods especially milk and dairy products 5/22/2017 4 SOFT TISSUE 100,000 mg 5/22/2017 5 Calcium requirements high for Growing children Women who are pregnant or breast-feeding 5/22/2017 6 Essential for normal maintenance and function of: Nervous, muscular, skeletal systems Cell membrane and capillary permeability Catalyst in many enzymatic reactions Essential in many physiologic processes Transmission of nerve impulses Contraction of cardiac, smooth, and skeletal muscles Renal function, respiration, and blood coagulation 5/22/2017 7 Calcium deficiency: hypocalcemia Infantile rickets Adult osteomalacia Osteoporosis Many other conditions associated with calcium deficiency 5/22/2017 8 Inadequate intake of calcium or vitamin D Hypoparathyroidism Malabsorption syndrome Many other causes 5/22/2017 9 Used to treat various deficiency states Dietary supplement for women during pregnancy and lactation Toxicity: Hypercalcemia may occur with therapy Anorexia, nausea, vomiting, constipation Stone formation Physical drug interaction: Calcium salts will bind (chelate) with tetracyclines to produce an insoluble complex 5/22/2017 10 Main source of dietary Ca in industrialized societies is milk which contains ~1150 mg ca/L. Other good sources of calcium include milk products except butter and cream, sardines, salmon, shellfish (oysters, tulya), dried dilis, green vegetables that do not contain much phytates and oxalates like mustasa, malunggay, petsay, saluyot, and gabi leaves calcium set tofu, some legumes, canned fish, seeds, nuts, and fortified food products. Breads and cereals, although relatively low in calcium, contribute significantly to total calcium intake because of the frequency of consumption. Fish and other seafoods contain more calcium than pork, beef, or chicken. 5/22/2017 11 5/22/2017 12 Menopausal women should take at least 500 to 2000 mg of calcium daily for minimum of 2 years to prevent bone loss. It is also recommended that dose of 400 to 800 iu of vitamin D3 be given with 1000 mg calcium to reduce hip fracture risk of older individuals esp those with limited sun exposure, ie. housebound. It is not routinely recommended to give vitamin D analogues. 5/22/2017 13 % Elemental Calcium Cost Convenience Absorption CaCO3 40 Inexpensive Convenient Adequate when taken with food Ca lactate 13 Inconvenient: need more tablets Adequate when taken with food Ca gluconate 9 Inconvenient IV Adequate when taken with food Ca citrate 21 5/22/2017 Expensive Well absorbed Levine In: DeGroot, 2001 14 One of the principal cations of intracellular fluid Essential for enzyme systems associated with energy metabolism Required for: Nerve physiology Muscle contraction 5/22/2017 15 Dietary sources Vegetables and other foods Required in higher amounts in those with diets high in protein-rich foods, calcium, and phosphorus 5/22/2017 16 Hypomagnesemia Malabsorption Alcoholism Long-term IV feedings Diuretics Metabolic disorders (hyperthyroidism, diabetic ketoacidosis) 5/22/2017 17 Nutritional supplement Treatment of magnesium deficiency Anticonvulsant in magnesium deficiency Preeclampsia and eclampsia Tocolytic agent for inhibition of uterine contractions in premature labor Many other uses 5/22/2017 18 Adverse effects are due to hypermagnesia Tendon reflex loss: form of paralysis Difficult bowel movements CNS depression Respiratory distress Heart block Hypothermia 5/22/2017 19 Infants (0-5 mos): 26 mg 6 to < 12 mos: 54 mg Children (<10 years): 65-100 mg 10-12 yrs: 155-160 mg; 13-18 yrs 220-260 mg Male adults: 235 mg Female adults: 205 mg Pregnant: 205 mg Lactating: 250 mg 5/22/2017 20 Widely distributed in foods Dietary deficiency is rare Deficiency due to non-dietary causes Mal-absorption Extensive diarrhea or vomiting Hyperthyroidism Long-term use of aluminum or calcium antacids Hepatic disease 5/22/2017 21 Required precursor for the synthesis of essential body chemicals Responsible for cellular energy transfer Necessary for the dev’t and maintenance of the skeletal system and teeth Building block for body structures Required for the synthesis of: Nucleic acid – AMP ADP – ATP 5/22/2017 22 Treatment of deficiency states Dietary supplement 5/22/2017 23 Diarrhea Nausea and vomiting Other GI disturbances Confusion Weakness Breathing difficulties 5/22/2017 24 Infants (< 6 mos): 90 mg 6 to < 12 mos: 275 mg Children: 460-500 mg 10-18 years old: 1250 mg adults: 700 mg Pregnant and Lactating: 700 mg 5/22/2017 25 Trace element Essential in metabolic reactions of proteins and carbohydrates Important for normal tissue growth and repair, especially wound repair Recently recognized as important for the prevention of recurrent diarrhea 5/22/2017 26 Infants (<6mos): 1.4 mg 6- <12 mos: 4.2 mg Children: 4.5-5.4 mg Male adults: 6.4 mg Female adults: 4.5 mg Pregnant 1st trim 5.1 mg, 2nd trim 6.6, 3rd trim 9.6 Lactating: 11.5 mg 5/22/2017 27 Appendix C: Food Tips a. Food based solutions are preferable to help ensure a balanced diet and good eating habits. b. 2 glasses of high calcium milk each day is a guaranteed way to meet all your calcium requirements. In addition, milk provides large amounts of phosphorus and components such as lactose and casein phosphopeptides which may enhance calcium absorption. c. Some fortified milks also supply adequate amounts of vitamin D, zinc, and magnesium for optimal bone health. d. Other sources of calcium include green leafy vegetables and soy products, although calcium is less well absorbed from these sources. e. Eat green vegetables cooked, rather than raw, to boost their calcium content. Cooking releases some of the calcium that’s bound to a compound called oxalic acid. f. Don’t take iron supplements with calcium-rich foods, since these minerals compete for absorption. g. Drink tea and coffee between, rather than during meals. Natural compounds in these beverages inhibit calcium absorption. 5/22/2017 28