Essential trace elements

Trace elements

1. Trace Elements Dr Manjuprasad Moderater:Dr Ravichandra V 1

2. Overview Introduction Classification Individual trace elements conclusion 2

3. Introduction Naturally occurring, homogeneous, inorganic substance required in humans in amounts less than 100 mg/day Minerals for 5% of our diet 3

4. Classification Essential trace elements Iron, zinc, copper Co, Cr, fluoride, iodide, Mn , Mo, & Se Probably essential trace elements Ni, tin, vanadium, Si, Bo Non essential trace elements Al, Au, Ba, Br, lead, silver, mercury, rubidium, strontium, titanium, ziroconium , 4

5. Essential trace elements Trace elements Iron, zinc and copper Ultra trace elements Manganese, selenium, cobalt, chromium, fluoride, iodine, and molybdenum 5

6. Iron Most essential trace element Body content – 4-6g Hb – 68% ferritin – 13 % haemosiderin – 12% myoglobin – 3% iron enzymes – 0.2% 6

7. Iron dependent enzymes: Cytochrome oxidase, xanthine oxidase and peroxidase Body requirement Daily requirement – 0.5 - 2 mg/day 3 - 5mg/day (pregnancy) Daily excretion – 0.9mg/day 1.3mg/day (during menses) 7

8. Dietary source: Leafy greens, whole grains, beans , pulses, liver, spleen, mollusks Iron is absorbed in ferrous form, which is measurable in blood as free iron 8

9. Transferrin Transport protein Binds to two iron molecules Transports iron to various organs and tissues S.Iron + total iron bound transferrin – total iron in circulation Determination of transferrin gives TIBC Transferrin can be measured by RIA, ELISA & chemiluminescence 9

10. Ferritin Protein having 24 subunits binds to 4000 iron molecules Measurements used to assess iron stores in the body ↑ferritin levels may be seen in hepatitis, cirrhosis, hepatic carcinoma also in leukemia, NHL RIA, ELISA chemiluminescence 10

11. 11

12. Deficiency state: asymptomatic weakness , headache, irritability, and varying degrees of fatigue and exercise intolerance . Treatment: 3-6mg of elemental iron/kg/day 12

13. Oral preparations of iron: Ferrous sulphate Ferrous fumerate Ferrous gluconate Ferrous succinate Iron calcium complex Ferric ammonium citrate Adverse effects: epigastric pain, nausea, vomiting, gastritis, metallic taste, constipation or diarrhea Liquid prep- staining of teeth 13

14. Parenteral preparations: Iron dextran Iron sorbitol citric acid complex Adverse effects: Pain at injection site, pigmentation Fever, headache, palpitations, anaphylaxis 14

15. Acute iron poisoning 60mg/kg elemental iron Vomiting, abdominal pain, bloody diarrhea, shock, dehydration, cyanosis, acidosis, coma Treatment: Gastric lavage with sodium bicarbonate solution D esferrioxamine 15 mg/kg per hour IV, ↑ to max 35 mg/kg per hour Correction of acidosis and shock (if fails dialysis) 15

16. Zinc Second most abundant trace element Cofactor – DNA polymerase, alkaline phosphatase, carboxypeptidase Regulate- growth, immune system, collagen synthesis, wound healing, bone metabolism, reproduction, taste, smell & vision 16

17. Reduce the time period of diarrhea High dose of zinc prevents dysmenorrhea Zinc required in producing testosterone For common cold In treatment of warts 17

18. Body content 2.5g 60% in muscle, 30% in bone, 10% in body tissues and organs Daily requirement: 3-14mg Diet rich in zinc: red meat, fish, sea food, pumpkin, cashews, beans, dark chocolate 18

19. Zinc deficiency: Leukemia, cirrhosis, hepatitis, sickle cell anemia, Malnutrition Symptoms: In children- growth retardation & skeletal abnormalities In adults- ↓smell & taste, ↓appetite, skin lesions, and hair loss 19

20. Zinc deficiency is also associated with Acrodermatitis enteropathica Anorexia Esophageal squamous cell carcinoma Cognitive and motor impairement Diarrhea and pneumonia Treatment: Zinc supplements 45 – 100mg/day 20

21. Copper 3rd most important trace element D iet rich in copper: red meat, shell fish, water pumped through copper pipes Body content of copper is 80-120mg 21

22. 40-60% absorbed in duodenum Transported through metallozymes eg ascorbic acid 90% bound to ceruplasmin , 9% to albumin and 1% is free Body content of Cu is 80-120mg 22

23. Body functions: Erythropoiesis Nerve conduction and immune function Fertility and to maintain pregnancy Act as a catalyst for copper containing enzymes Eg : tyrosinase , ascorbic acid 23

24. Toxic – 5mg/kg Adequate – 34mcg/kg Deficient - <8.5mcg/kg RDA – 09 - 1.3mg/day 24

25. Deficiency symptoms: Fragile hair Depigmented skin Myeloneuropathy Edema Hepatosplenomegaly Osteoporosis Anemia, neutropenia 25

26. Menkes disease Congenital X-linked genetic disorder Mutation in ATP7A gene Inactivating mutation in this gene causes Cu deficiency 26

27. Wilsons disease Autosomal recessive disorder Mutation in ATP7b gene Causes excessive accumulation of Cu Clinical features: Diarrhea, vomiting Cardiac & renal failure Hepatic necrosis encephalopathy 27

28. Treatment: life long treatment Avoidance of high Cu diet In early stages Zn may be effective as it competes with Cu for absorption Penicillamine 28

29. Chromium In 1957, extracted from pork kidney and they named it as “glucose tolerance factor” as it corrected hyperglycaemia . Regulates plasma lipoprotein concentration and reduces cholesterol and triglycerides. Found in – grains, cereals, fruits, processed meat 29

30. RDA : 20 – 35 mcg/ day In improving lean body mass Deficiency: Limited to hospitalized patients on TPN Toxicity : Lung Ca , Bronchogenic Ca in stainless steel workers Dermatitis, skin ulcers 30

31. Fluoride Very important in preventing dental caries Promotes remineralization of decalcified enamel Available as tooth paste, solutions and gels Excess cause flurosis Rx - tooth bleeching , microabrasion , replacement 31

32. Iodine Thyroid hormone synthesis and also have broad spectrum germicidal action Iodine induced hyperthyroidism: -In individuals of nodular goiter in endemic area -thyrotoxicosis due to underlying areas of autonomy ( Jod Basedow phenomenon) 32

33. Iodine induced hypothyroidism: people at risk are- autoimmune thyroiditis, Graves hyperthyroidism previously treated with radioactive iodine Unusually sensitive to inhibitory effect due to sustained activity on Na/I symporter ( Wolff Chaikoff effect ). 33

34. Iodine deficiency prophylaxis: Iodised salt Iodised oil Iodised water Iodine tablets or drops Biofortification of vegetables with iodine Also available as ointment, solution, mouth gargles 34

35. Manganese Shown to be essential for normal growth and development Role in human health unclear Dietary sources: meat, fish, poultry, dry fruits and nuts 35

36. Biological role: manganese superoxide dismutase arginase , glutamate synthase & pyruvate carboxylase Deficiency : Experimental animals - ↓growth, ↓fertility, ataxia, skeletal deformities, abnormal fat and CHO metabolism 36

37. Toxicity: Neurotoxic- extrapyramidal parts affected Headache Hepatic dysfunction RDA – 2-11mg/day 37

38. Molybdenum Act as a catalyst for enzymes and helps facilitate breakdown of certain amino acids Molybdenum in human tooth enamel may have a role in lowering the risk of  tooth decay. Deficiency – esophageal carcinoma RDA: 45mcg/day pregnancy and lactation 50mcg/day 38

39. Selenium Least abundant trace element Recommended intake for adults 50-200 μg /day Functions in human body: Selenium in Glutathione peroxidase (GTH- Px )- important role immune system function, also plays a crucial role in the control of oxygen metabolism. 39

40. Functions in human body: protects body from oxidative damage . Low GTH- Px in platelets leads to bleeding disorders & edema due to damage to capillary membranes Protects phagocytes from destruction GTH- Px protects eye lens tissues and neurons from damage 40

41. Low Selenium leads to Keshan’s disease, which is a type of cardiac myopathy discovered in china where soil Selenium was absent. Selenium deficiency occurs due to : •Hemolytic anemia •Clansman's thrombasthenia (platelet disorder ) •Gastrointestinal cancer •Malnutrition 41

42. Vanadium Control of sodium pump, inhibition of ATPase Tin Interaction with riboflavin metabolism Silicon Structural role in connective tissue, in metabolism of osteogenic cells Nickel Component of enzyme urease 42

43. Boron Boron is a vital trace mineral that is required for the normal growth and health of the body.  apples, oranges, red grapes, kiwis, dates , as well as certain vegetables, avocado, soybeans and nuts are rich sources of boron 43

44. Health benefits: Prevents arthritis Used for body building Estrogen Production: Boron can improve the production of estrogen in menopausal women Embryonic development: Boron appears to be essential for reproduction and the development of the fetus Proper cell membrane functions Lowers plasma lipid levels 44

45. Lithium Discovered in 1817 as mood stabilizing agent MOA: Inositol depletion theory Inhibition of NMDA receptor mediated signalling Inhibition of GSK3 BDNF upregulation 45

46. Adverse effects: Nephrogenic diabetes insipidus Thyroid function abnormalities mental confusion hyperreflexia gross tremor dysarthria Seizures cardiac arrhythmias, hypotension , and albuminuria. 46

47. Uses BPD Mania Depression Cancer induced leukopenia & agranulocytosis Preparation: Lithium carbonate 150/300/600mg Lithium citrate syrup 8mEq/5ml 47

48. Xenon A trace element in earths atmosphere Xenon is a medical gas capable of establishing neuroprotection , inducing anesthesia and nuclear medicine as a contrast agent Acts through NMDA receptor 48

49. Bibliography Pharmacological aspects of therapeutics – Goodman and Gilman – 12 th edition Textbook of medical pharmacology – Dr.PadmajaUdaykumar – third edition Katzung BG, Masters SB, Trevor AJ. Basic and Clinical Pharmacology.12 th ed : Food and Nutrition Board of the Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. National Academies Press, Washington DC, 2000. www.nap.org (Accessed on May 03, 2012 ). Turnlund JR. Copper. In: Modern nutrition in health and disease, 10th, Shils ME, Shike M, Ross AC, et al ( Eds ), Lippincott Williams and Wilkins, Baltimore 2006. p.286. 49

50. Trace elements in human nutrition. Report of a WHO expert committee. Report No. 532, World Health Organization, Geneva, 1973. Danks D. Hereditary disorders of copper metabolism in Wilson's disease and Menkes ' disease. In: The metabolic basis of inherited disease, 5th, Stanbury JB, Wyngaarden JB, Fredrickson DS, et al ( Eds ), MacGraw -Hill, New York 1983. Stamp TC. Fluoride. In: Encyclopedia of food science, food technology, and nutrition, Macrae R, Robinson RK, Sadler MJ ( Eds ), Academic Press, London 1993. p.1932. Nielsen FH. Ultratrace minerals. In: Modern nutrition in health and disease, 9th, Shils ME, Olson JA, Shike M, Ross AC ( Eds ), Williams and Wilkins, Baltimore 1999. p.283. 50