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Fluorine, selenium, manganese, molybdenum, cobalt

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Dr. Ashish Agravatt MBBS, MD.

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Fluorine

Source

RDA

Functions

Deficiency

Toxicity

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Fluorine - source

Drinking water

Depends upon fluorine content in the soil

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Fluorine - rda

1ppm

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Fluorine - functions

Increases hardness of bone and teeth

Required for normal dentition

Prevents dental caries

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Fluorine - deficiency

Cause

Drinking water that is low in fluorine content

Feature

Dental caries

Drinking water containing less than 0.5ppm of fluoride

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Fluorine - toxicity

Cause

Drinking water with fluorine more than 5ppm

Features

Dental fluorosis and skeletal fluorosis

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Fluorine - toxicity

Dental fluorosis

Mottling of enamel

Discoloration of teeth

Skeletal fluorosis

Bowed legs

Bending of spine

Osteoporesis

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Trace Minerals

9

July 6, 2021

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Trace Minerals

10

July 6, 2021

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selenium

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SELENIUM - SOURCES

Sea foods

Meat

Liver

Kidney

Plants

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SELENIUM - rda

100 µg/day

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SELENIUM –FUNCTIONS

Glutathione peroxidase

    • As an antioxidant

Deiodinase

    • Converts T4 to T3

Selenocysteine

    • 21st amino acid

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SELENIUM – DEFICIENCY

Causes

    • Low soil content of selenium
    • Parenteral nutrition

Features

    • Cirrhosis of liver
    • Cardiomyopathy
    • Muscular dystrophy

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Selenium - toxicity

    • Rare
    • Seen in people who handle metal polishes and antirust compounds

Cause

    • Hair loss
    • Dermatitis

Features

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MANGANESE

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MANGANESE – SOURCE & RDA

Whole grain cereals

Vegetables

Nuts

5mg/day

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MANGANESE - FUNCTIONS

Pyruvate carboxylase

    • Gluconeogenesis

Acetyl CoA carboxylase

    • Fatty acid synthesis

Superoxide dismutase

    • Suppression of oxidative stress

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molybdenum

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Molybdenum – SOURCES & RDA

Milk

Beans

cereals

RDA

200 µg/day

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Molybdenum - functions

Xanthine oxidase

    • Catabolism of purines

Sulfite oxidase

    • It oxidizes sulfite to sulfate 

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COBALT

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COBALT - FUNCTIONS

Methycobalmine

    • Homocysteine methy transferse

Deoxyadenosyl cobalamine

    • L- methyl malonylCoA mutase

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MINERALS�COPPER

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COPPER

Sources

RDA

Metabolism

Functions

Disorders

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COPPER - SOURCES

    • Liver
    • Kidney
    • Meat
    • Egg
    • Cereals
    • Green leafy vegetables
    • Nuts

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COPPER - RDA

    • 2-3 mg/day

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COPPER - METABOLISM

Absorption

    • Upper small intestine
    • Efficacy 10%

Transport

    • Ceruloplasmin
    • Copper-albumin complex

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PLASMA COPPER

    • Plasma copper is 100-200 µg/dl
      • 90% bound to CPL

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      • 10% bound to albumin
    • Normal serum ceruloplasmin 25-50mg/dl
      • Glycoprotein

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      • Serum ferroxidase

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COPPER - FUNCTIONS

Copper is a component of many enzymes

Ceruloplasmin- Iron transport

Tyrosinase – Biosynthesis of melanin

Lysyl oxidase – Collagen biosynthesis

Cytochrome oxidase – ETC

Tryptophan pyrrolase – Catabolism

Superoxide desmutase – Antioxidant

Dopamine hydroxylase – catecholamine synthesis

ALA synthase – Heme synthesis

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COPPER DEFICIENCY

Causes

Malnutrition

Malabsorption

Nephrotic syndrome

Features

Anaemia, cardiac failure

Hypopigmentaion of the skin

Growth retardation

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COPPER TOXICITY

Causes

Excessive intake

Wilson’s disease

Features

Nausea, vomiting, diarrhea

Hepatitis, cirrhosis

Renal dysfunction

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INBORN ERRORS OF COPPER METABOLISM

    • Menke’s syndrome

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    • Wilson’s disease

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MENKE’S SYNDROME�MENKE’S KINKY HAIR SYNDROME

Cause

Inheritance

Features

Lab findings

Treatment

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MENKE’S SYNDROME

CAUSE

Defect in transport of copper from intestinal mucosal cell to blood

Due to mutation in the gene encoding copper binding P type of ATPase

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MENKE’S SYNDROME

    • Inheritance
      • Sex linked recessive disorder

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MENKE’S SYNDROME

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FEATURES

Males are affected (Infants)

Growth failure

Mental retardation

Abnormal hair [Kinky or silky hair]

Fatal, death occurs at early life

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MENKE’S SYNDROME

    • Biochemical findings
      • Low serum copper
      • Low serum ceruloplasmin

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MENKE’S SYNDROME

Treatment

    • There is no effective treatment for this condition

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WILSON’S DISEASE

Cause

Inheritance

Features

Lab findings

Treatment

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WILSON’S DISEASE

CAUSE

Defect in transport of copper and secretion of ceruloplasmin from the liver

Due to mutation in the gene encoding copper binding P type of ATPase in liver

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WILSON’S DISEASE

    • Inheritance
      • Autosomal recessive disorder

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WILSON’S DISEASE

    • Features
      • Hepatitis, Cirrhosis
      • Tremor, dementia
      • Kayser- Fleischer ring
      • Amino aciduria, glycosuria

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WILSON’S DISEASE

Lab findings

Decreased serum copper

Decreased serum ceruloplasmin

Increased serum copper excretion in urine

Marked accumulation of copper in liver

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WILSON’S DISEASE - TREATMENT

    • Diet low in copper
    • Administration of copper chelator
      • Penicillamine

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MINERALS - IODINE

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IODINE

SOURCE

RDA

METABOLISM

FUNCTION

DEFICIENCY

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IODINE - SOURCES

    • Sea foods
    • Egg
    • Dairy products
    • Iodized salt
    • Drinking water
    • Vegetables

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IODINE - RDA

    • 150 µg/day

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IODINE - METABOLISM

    • Absorption
      • Upper small intestine
    • Transport
      • Binding loosely to plasma proteins
    • Storage
      • 80% in thyroid gland
    • Excretion
      • 2/3rd in urine

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IODINE - FUNCTION

Required for the synthesis of thyroid hormones

T4 and T3

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IODINE DEFICIENCY - CAUSES

DIETARY DEFECIENCY

    • Goitre belt

GOITROGENS

    • Thiocyanates
    • Thiourea

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IODINE DEFICIENCY - FEATURES

Goiter

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IODINE DEFICIENCY

    • Treatment
      • Potassium iodide

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MAGNESIUM

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MAGNESIUM

Sources

RDA

Distribution

Functions

Disorders

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MAGNESIUM - SOURCES

    • Green leafy vegetables
    • Cereals
    • Nuts
    • Sea foods

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MAGNESIUM - RDA

    • 300-400 mg/day

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MAGNESIUM - DISTRIBUTION

    • Total body magnesium is 25gm
      • 67% in bone

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      • 32% in cells
    • Extra cellular magnesium is 1%
    • Plasma magnesium
      • 1.8 – 2.5mg/dl

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MAGNESIUM - FUNCTIONS

Activator of many enzymes

Maintain normal muscle and nerve function

Needed for healthy bones and teeth

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MAGNESIUM - DISORDERS

    • Hypomagnesaemia
    • Hypermagnesaemia

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HYPOMAGNESAEMIA

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CAUSES

Malnutrition, alcoholism

Malabsorption

Renal tubular acidosis

Toxemia of pregnancy

Drugs - diuretics

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HYPOMAGNESAEMIA-FEATURES

Muscle cramps and tetany

Cardiac arrhythmias

Ataxia, tremor

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HYPERMAGNESAEMIA

CAUSES

Chronic renal failure

Rhabdomyolysis

FEATURES

Muscle weakness

Hypotension

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MINERALS - ZINC

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ZINC

Source

RDA

Absorption

Distribution

Function

Deficiency

Toxicity

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ZINC

    • Grains
    • Beans
    • Nuts
    • Meat
    • Shellfish

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ZINC - RDA

    • 10mg/day

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ZINC - ABSORPTION

    • Site
      • Upper small intestine
    • Factors
      • Calcium
      • Phosphate
      • Phytate
    • Efficiency
      • 10 – 15%

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ZINC - DISTRIBUTION

    • Human body total Zinc – 2gm
      • 60% present in muscles
      • 30% present in bone
      • Prostate, liver, brain and skin

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ZINC - FUNCTIONS

    • Component of many metalloenzymes

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    • Maintenance of integrity of skin

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    • Growth and reproduction

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    • Zinc stabilizes Insulin
    • Component of transcription factor

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    • Regulation of immune function

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    • Wound healing

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    • Component of Gusten

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ZINC - DEFICIENCY

Causes

    • Dietary deficiency
    • Malabsorption
    • Chronic alcoholism

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ZINC – DEFICIENCY FEATURES

Hypogonadism

Growth failure

Delayed wound healing

Dermatitis

Alopecia

Loss of appetite

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ACRODERMATITIS ENTEROPATHICA

    • Cause
      • Inherited disorder of zinc metabolism
      • Results from defective Zinc absorption

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    • Features
      • Features of Zinc deficiency
      • Acrodermatitis of mouth, nose & fingers
      • Diarrhea, alopecia, hypogonadism

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ZINC - TOXICITY

Causes

    • Rare
    • Seen in welders due to inhalation of zinc oxide fume

Features

    • Vomitting, diarrhea, stomach cramps
    • Fever

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