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Calcium physiology (Multimedia)

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Calcium metabolism

Total body calcium amounts to around 1-2 kg (98% in skeleton).

The plasma level is around 8.5-10.4 mg%. In plasma it is found in 3 main forms:

  1. Free ionized (Active) 45%
  2. Bound (Proteins) 40%
  3. Combined diffusible (Salts)15%

Calcium homeostasis

About 2/3 of the daily quantity of ingested calcium is excreted by the gut the remaining 1/3 is absorbed into the circulation where it reaches the extracellular fluid. From the extracellular fluid calcium reaches bone. Finally it reaches the kidneys, here calcium is partially reabsorbed back into the circulation. The remainder that is excreted is the same as the amount absorbed from the intestines.

Control of serum calcium

The level of calcium in the extracellular fluid is under hormonal control. Parathyroid hormone secretion is stimulated once calcium level decreases by a negative feedback mechanism. Parathyroid hormone secretion stimulates kidney and bone to increase the plasma level of calcium. The kidneys do so by distal tubular reabsorption of calcium and the activation of vitamin D. Bone responds to parathormone by increasing osteolysis. Other hormones involved include vitamin D and calcitonin. Vitamin D is responsible for increasing the intestinal absorption of calcium while calcitonin antagonizes the action of parathormone in bone by decreasing osteolysis.

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