METABOLISME

MINERAL
By
EDY WALIYO, S.Gz

2004 Dr. Hamda Qotba 1

 Mineral
1) Mineral bagian dari tbh berperan dalan
pemeliharaan fungsi tbh.
2) Befungsi sbg kofaktor dalam aktivitas
enzim-enzim
3) Keseimbangan ion-ion mineral di dalam
cairan tubuh, untuk:
- Pengaturan pekerjaan enzim-enzim
- Pemeliharaan keseimbangan asam-basa
- Membantu transfer ikatan-ikatan penting melalui
membran sel
- Pemeliharaan kepekaan otot dan saraf terhadap
rangsangan
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 Mineral

Makro Mikro

- Mineral yg dibutuhkan tubuh - Mineral yg dibutuhkan tubuh

dalam jumlah > 100 mg/hr- dalam jumlah < 100 mg/hr-
- Kandungan di dalam tubuh 35 1.400 g - Kandungan di dalam tubuh <1mg 4 g
- Mineral Makro: Ca, P, Mg, Na, K dan Cl - Mineral Mikro: 24 mineral

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 Calcium
Kandungan 1,5 2 % dari BB org dewasa (1 1,4
g dgn BB 70 kg)
99% Ca didlm jaringan keras (gigi dan tulang)
dan 1% Ca cairan intra & ekstrasellular
Fungsi
Pembentukan tulang dan gigi
Mengatur Pembekuan darah
Katalisator reaksi-reaksi biologik
Kontraksi otot
Absorsi
30 35% Ca diabsorbsi tbh (normal)
Terjadi dibagian usus halus duodenum
Membutuhkan pH 6 dapat terlarut

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 ABSORBSI CALSIUM

MUKOSA

MAKANAN ABSORBSI USUS 10 %, 30 50 %

T.GINJAL
VIT. D
pH Usus

Defisiensi Ca kronis
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 FAKTOR MEMPENGARUHI
ABSORBSI KALSIUM
* Asam Oksalat -- kalsium oksalat - tdk larut

*Asam Fitat --- mengikat kalsium

*Steatorhea Diet Tinggi Lemak - Menurunkan absorbsi

*Tingginya Mobilitas Lambung Menurunkan absorbsi

*Kurang Olah Raga - Menurunkan absorbsi 0,5 %/ bl

* Serat - Meningkatkan mortilitas sal. cerna

* Kafein, Obat-obatan

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 EKSKRESI CALSIUM
* FESES 90 %

* URINE (normal : 2.5-7.5 m Mol / 24 jam dalam serum

* PLANSENTA

* LAKTASI : 200 300 mg/l A

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 TINGKAT KONSUMSI KALSIUM

ASI Kalsium 50 mg/Kg Bb/hari

BAYI
FORMULA 65 mg/Kg BB/Hr

ANAK 1 10 th Absorbsi 75 % kalsium

REMAJA Retensi kalsium 500 mg/hr 1200 1500mg/hr

UMUR 30 Th Kebutuhan kalsium menurun

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 Calcium
Sources
dairy product, fortified flour, egg,leafy
vegetable, fish, cabbage, broccoli
Requirement
Adult 500mg/day, Pregnancy 1200mg/day
excreted in urine and feces
Deficiency
Rickets in children & Osteomalacia in adult

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Pengendalian Kalsium dalam
Darah
Parathyroid hormone (PTH)

Calcitriol (active form of vitamin D3)

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 Role of PTH
Stimulates renal reabsorption of calcium
Inhibits renal reabsorption of phosphate
Stimulates bone resorption
Inhibits bone formation and mineralization
Stimulates synthesis of calcitriol

Net effect of PTH serum calcium

serum phosphate

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 Regulation of PTH

Low serum [Ca+2] Increased PTH secretion

High serum [Ca+2] Decreased PTH secretion

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 Role of Calcitriol
Stimulates GI absorption of both
calcium and phosphate
Stimulates renal reabsorption of both
calcium and phosphate
Stimulates bone resorption
Net effect of calcitriol serum calcium
serum phosphate

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 Regulation of Calcitriol

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 Overview of Calcium-Phosphate
Regulation

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 Different Forms of
Calcium
At any one time, most of the calcium in the body exists as the
mineral hydroxyapatite, Ca10(PO4)6(OH)2.

Calcium in the plasma:

45% in ionized form (the physiologically active form)
45% bound to proteins (predominantly albumin)
10% complexed with anions (citrate, sulfate, phosphate)

To estimate the physiologic levels of ionized calcium in states

of hypoalbuminemia:

[Ca
2004
+2]
Corrected = [Ca+2]
Measured
Dr.
+ [ 0.8 (4 Albumin) ]
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 Overview of Biochemical
Homeostasis

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 Overview of Calcium
Balance

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 HIPERKALSEMIA

MANIFESTASI KLINIK
Depresi susunan saraf pusat (letargi ringan
sampai koma)
Anoreksia
Mual
Konstipasi
Pengendapan kalsium pada mata
Poliuria
polidipsia
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 Etiologies of Hypercalcemia
Increased GI Absorption Decreased Bone Mineralization
Milk-alkali syndrome
Elevated calcitriol Elevated PTH
Vitamin D excess Aluminum toxicity
Excessive dietary intake
Granuomatous diseases
Elevated PTH Decreased Urinary Excretion
Hypophosphatemia
Thiazide diuretics
Increased Loss From Bone Elevated calcitriol
Increased net bone resorption
Elevated PTH Elevated PTH
Hyperparathyroidism
Malignancy
Osteolytic metastases
PTHrP secreting tumor
Increased bone turnover
Pagets disease of bone
Hyperthyroidism

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 Diagnosis

Manifestasi Klinik
Hiperparatiroidisme primer
Riwayat obat (vitamin dan antasida)
Pemeriksaan Lab
Fosfat serum
Fosfatase alkali

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 Pemeriksaan

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 Etiologies of Hypocalcemia
Decreased GI Absorption
Increased Urinary Excretion
Poor dietary intake of calcium Low PTH
Impaired absorption of calcium
s/p thyroidectomy
Vitamin D deficiency
Poor dietary intake of vitamin D s/p I131 treatment
Malabsorption syndromes Autoimmune hypoparathyroidism
Decreased conversion of vit. D to calcitriol PTH resistance
Liver failure
Vitamin D deficiency / low calcitriol
Renal failure
Low PTH
Hyperphosphatemia

Decreased Bone Resorption/Increased Mineralization

Low PTH (aka hypoparathyroidism)
PTH resistance (aka pseudohypoparathyroidism)
Vitamin D deficiency / low calcitriol
Hungry bones syndrome
Osteoblastic metastases
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 Iron
Function
Formation of hemoglobin
Constituent of enzyme

Storage
Liver, bone marrow & spleen in the form
of ferritin
Absorption
facilitated by ascorbic acid
inhibited by phytic acid, lack of gastric
secretion
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 Iron
Sources
Meat, egg, flour, bread, leafy vegetable,
liver, kidney, dried fruits
Requirement (10-15mg/day)
To replace loss from urine, bleeding
& menstruation
Formation of additional hemoglobin

In lactation

Deficiency
IDA
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 Deficiency
Symptoms
Anemia: a reduction of the
number & size of RBCs and a
loss of their color
Characterized by weakness,
paleness, headaches, reduced
immunity, inability to
concentrate, cold intolerance
2004
Blood loss
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 Toxicity
Symptoms
Iron overload
Infections
Liver injury
Acidosis
Shock
 Food Sources
Red meat
Poultry
Fish & shellfish
Eggs
Legumes
Dried fruits
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 Seng (Zn)
Tubuh mengandung 2 2,5 gr tersebar
hampir semua sel
Berada didalam hati, pankreas, ginjal,
oto dan tulang
Jaringan yg terbanyak megamdung seng
mata, kelenjar prostat, spermatozoa,
kulit rambut dan kuku
Seng merupakan ion intraselular
Seng didalam plasma hamya 0,1%

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 Seng Makanan

Sel saluran cerna

Siklus Menyimpan sebagian Sbgian hilang mllalui feses &
enteropankreatik sbg metalotionein sel sal.cerna yg dibuang

Mengikatkan seng ke albumin dan transferin

Darah mengangkut seng

dalam albumin dan transferin

Hati
Pangkreas membentuk enzim
pencernaan dari seng &
mengeluarkannya
kedalam saluran cerna Menyimpan kelebihan
sbg metalotionein
Darah membawa seng dlm
Sebagian hilang mllui urin, albumin ke jaringan tubuh lain
kulit, darah & mani

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 Absorbsi
Yg diabsorbsi 15 40%
Serat & Fitat menghambat ketersediaan
biologik seng.
Cu melebih Kebutuhan faal menghambat
absorbsi
Protein histidin membantu absorbsi
Albumin alat transport seng
Albumin menurun absorbsi seng menurun
Eksresi melalui feses, urin, jar.kulit, sel
dinding usus, cairan haid dan mani

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 Fungsi

Functions:
Needed for protein & enzyme
function
Immunity & wound healing
Vitamin A transport
Taste
Fetal development
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 Deficiency
Symptoms
Growth failure in children
Loss of taste
Poor wound healing
Poor appetite

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 Toxicity
Symptoms
Fever
Nausea
Vomiting
Diarrhea
Kidney failure
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 Food Sources
Protein-containing foods:
Meat
Fish & shellfish
Poultry
Grains
Vegetables
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 C. Iodine
Amount of iodine in food is
reflected in the soil
Functions:
Part of thyroxine, which
regulates metabolism

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 Deficiency
symptoms
Goiter: decreased blood iodine
causes thyroid cells to enlarge
Cretinism: severe mental & physical
retardation of an infant caused by
severe iodine deficiency in the mother
during pregnancy
Iodization of salt has all but eliminated
goiter & cretinism
2004
In some parts of the world, these45
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 Toxicity
Symptoms:
Depressed thyroid
activity accompanied by
an enlarged thyroid
gland

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 Fosfor (P)
Mineral ke-2 terbanyak di dalam tbh (1% dari
BB)
8%% sbg garam kalsium fosfat
P : Ca = 1:2 di dalam tulang
Merupakan bagian dari asam nukleat DNA
dan RNA
Merupakan komponen struktural dinding sel
(Fosfolipid)
Berperan dalam dengan penyimpanan/
pelepasan energi ATP

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 Fosfor
Fosfor Makanan
Alkalin Fosfatase
(Di dalam Mukosa Usus Halus)

Fosfor bebas

Absorbsi

Vitamin D Aktif Pasif

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