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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

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Most abundant mineral element in the body

Accounts for 2% of body weight Highest concentration in bones and

teethEfficient absorption requires

adequate amounts of vitamin DFound in many foods especially milk

and dairy products404/19/23

SOFT TISSUE100,000 mg

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Calcium requirements high for Growing children Women who are pregnant or breast-

feeding

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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

coagulation704/19/23

Calcium deficiency: hypocalcemia Infantile rickets Adult osteomalacia Osteoporosis Many other conditions associated with

calcium deficiency

804/19/23

Inadequate intake of calcium or vitamin D

HypoparathyroidismMalabsorption syndrome Many other causes

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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

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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.

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1204/19/23

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.

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% 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 InconvenientIV

Adequate when taken with food

Ca citrate 21 Expensive Well absorbed

Levine In: DeGroot, 2001 1404/19/23

One of the principal cations of intracellular fluid

Essential for enzyme systems associated with energy metabolism

Required for: Nerve physiology Muscle contraction

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Dietary sources Vegetables and other foods

Required in higher amounts in those with diets high in protein-rich foods, calcium, and phosphorus

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Hypomagnesemia Malabsorption Alcoholism Long-term IV feedings Diuretics Metabolic disorders (hyperthyroidism,

diabetic ketoacidosis)

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Nutritional supplementTreatment of magnesium deficiencyAnticonvulsant in magnesium

deficiencyPreeclampsia and eclampsiaTocolytic agent for inhibition of

uterine contractions in premature labor

Many other uses1804/19/23

Adverse effects are due to hypermagnesia Tendon reflex loss: form of paralysis Difficult bowel movements CNS depression Respiratory distress Heart block Hypothermia

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Infants (0-5 mos): 26 mg6 to < 12 mos: 54 mg Children (<10 years): 65-100 mg10-12 yrs: 155-160 mg; 13-18 yrs 220-260 mg Male adults: 235 mgFemale adults: 205 mg Pregnant: 205 mg Lactating: 250 mg

2004/19/23

Widely distributed in foodsDietary deficiency is rareDeficiency due to non-dietary causes

Mal-absorption Extensive diarrhea or vomiting Hyperthyroidism Long-term use of aluminum or calcium

antacids Hepatic disease

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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

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Treatment of deficiency statesDietary supplement

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DiarrheaNausea and vomitingOther GI disturbancesConfusionWeaknessBreathing difficulties

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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

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Trace elementEssential in metabolic reactions of

proteins and carbohydrates Important for normal tissue growth

and repair, especially wound repairRecently recognized as important for

the prevention of recurrent diarrhea

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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 mgPregnant 1st trim 5.1 mg, 2nd trim 6.6, 3rd trim 9.6 Lactating: 11.5 mg

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Appendix C: Food Tipsa. 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.

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