Phosphorus serum levels

Figure 8. The effect of different ration levels of calcium (Cai = O.37o and Ca2 = 1.2%) and phosphorus (Pi = 0.37> and P2 = 1.27 ) on mice serum levels. Top Ca-protein interaction P < 0.0007. Bottom Ca-protein interaction P < 0.0197.

Blood samples were centrifuged at 1000 x g for 20 min at 0-4°. Ionized calcium levels were immediately determined in serum and urine samples using a calcium ion-selective electrode (Ionetics, Inc., Costa Mesa, CA) urine volumes were recorded. The remaining serum and urine were aliquoted for various analyses and stored at -40°. Serum insulin was analysed by radioimmunoassay (Amersham Corp., Arlington Heights, IL). Serum levels of total calcium, phosphorus and creatinine as well as urine creatinine were determined by colorimetric procedures using an automated analyzer (Centrifichem, Baker Instruments Corp., Pleasantville, NY). Glomerular filtration rates (GFR) were calculated from serum and urine creatinine data GFR = urine creatinine/serum creatinine. 

The effects of varying either the calcium or phosphorus level in conjunction with a high beef meal on the urinary calcium excretion of men are shown in Table IV. Urinary calcium excretion (total and ionized) was significantly elevated (P < 0.005) when the high protein beef meal contained 466 mg rather than 166 mg calcium. Increasing the phosphorus level from 308 mg to 700 mg in the high beef meal reduced both total and ionized calcium excretion in the urine, but the response was not statistically significant. Serum levels of calcium (ionized and total) and phosphorus were within normal limits and were unaffected by any of the dietary treatments. 

Results. Table VI gives the serum levels of calcium (total and ionized) and phosphorus. Serum ionized calcium, which ranged from 33% to 36% of total serum calcium, did not respond postprandially to any of the diets consumed. 

In a study of 71 workers exposed to airborne white phosphorus for intermediate or chronic durations, 4.5% and 44%, respectively, developed phossy jaw (Ward 1928). Forty-eight male workers with exposure to white phosphorus ranging from 1 to 17 years were found to be normal and healthy with regards to many parameters, including serum levels of calcium and phosphorus, and bone density none of the men developed phossy jaw (Hughes et al. 1962). 

Vitamin D that is taken up by the fiver is converted to 25-hydroxyvitamin D by a microsomal hydroxylase (Fig. 30-3). 25-Hydroxyvitamin D is the main circulating form of vitamin D in the serum and the best indicator of vitamin D status. Normal serum levels are 14-60 ng/mL (35-150 nmol/L). When serum calcium concentrations decline, 25-hydroxyvitamin D is converted to 1,25-dihydroxyvitmin D by la-hydroxylase, a mixed-function oxidase that is located in the inner mitochondrial membrane in kidney tissue and whose expression is regulated by parathyroid hormone (PTH). The main function of 1,25-dihydroxyvitamin D is to increase the intestinal absorption of dietary calcium and phosphorus. When serum concentrations of calcium and phosphorus are normal or when large doses of vitamin D are administered, 25-hydroxyvitamin D is metabolized to 24,25-dihydroxyvitamin D in the renal... 

Several zinc absorption studies, using oral doses of ZnCl2 were carried out. 65zq plasma levels were determined serially on the day of the oral administration of the zn tracer. Urinary and fecal 65zn excretions were determined for approximately 15 days. The subjects studied were fully ambulatory males who were In good nutritional state. They were normal according to all clinical and laboratory criteria. Including the serum levels of zinc, calcium, and phosphorus. The effect of three Intake levels of calcium on the zinc balance was studied, namely, of 200, 900,... 

Biomarkers of exposure and effect are established for children. Since the primary biomarker of effect, rickets, is a late-stage phenomenon, it would be useful to establish precisely a constellation of biomarkers that would identify a precursor condition. Such markers might include relative serum levels of vitamin D, calcium, phosphorus, and phosphatases. The alginate method for reducing peak absorption of strontium has been validated in children (Sutton et al. 1971a). 

In conclusion, vitamin D yields a number of hy-droxylated derivatives some are active, some are inactive. The active pathway involves elaboration of a 25-hydroxyl metabolite in liver which is converted to an active compound in kidney. The 1,25-hydroxylated derivative, the latter compound, can be looked upon as a hormone whose production is delicately regulated by the serum levels of calcium and phosphorus. It is conceivable that the use of the derivatives might help to cure some form of vitamin D resistant bone diseases (see Fig. 5-6). 

Low serum levels also occur in cases of poisoning by organic phosphorus compounds, e.g. certain insecticides. These inhibit both types of enzyme. 

Vitamin D Vitamin D enhances the efficiency of the small intestine to absorb calcium and phosphorus from the diet and thus helps to maintain normal serum levels of these minerals. Vitamin D deficiency in infants and children results in inadequate mineralization of the skeleton, causing rickets, which is characterized by various bone deformations. The major source of vitamin D is its formation in the skin as a result of exposure to sunlight. Dietary sources include fortified foods, such as milk and cereals, and certain fish. Infant formula is fortified with vitamin D in many countries. Because human milk contains only low amounts of vitamin D, breast-fed infants who do not receive either supplemental vitamin D or adequate exposure to sunlight are at risk for developing vitamin D deficiency. Subclinical vitamin D deficiency can be assessed by measuring serum 25-hydroxyl-vitamin D deficiency occurs months... 

White phosphorus. This element burns in air and can produce severe thermal and chemical burns. It may reignite on drying. After washing, rapid but brief treatment with copper sulphate (to avoid systemic absorption and copper poisoning) is used to convert the phosphorus to copper phosphide which is then removed Hydrogen fluoride. This can form painful but delayed necrosis. Treat with calcium gluconate locally and monitoring of serum calcium levels, with administration of calcium where necessary... 

Methyl parathion was determined in dog and human serum using a benzene extraction procedure followed by GC/FID detection (Braeckman et al. 1980, 1983 DePotter et al. 1978). An alkali flame FID (nitrogen-phosphorus) detector increased the specificity of FID for the organophosphorus pesticides. The detection limit was in the low ppb (pg/L). In a comparison of rat blood and brain tissue samples analyzed by both GC/FPD and GC/FID, Gabica et al. (1971) found that GC/FPD provided better specificity. The minimum detectable level for both techniques was 3.0 ppb, but GC/FPD was more selective. The EPA-recommended method for analysis of low levels (<0.1 ppm) of methyl parathion in tissue, blood, and urine is GC/FPD for phosphorus (EPA 1980d). Methyl parathion is not thermally stable above 120 °C (Keith and Walters 1985). 

The management of secondary hyperparathyroidism involves correction of serum calcium and phosphorus levels, and decreasing parathyroid hormone secretion. 

As renal function declines in patients with CKD, decreased phosphorus excretion disrupts the balance of calcium and phosphorus homeostasis. 0 The parathyroid glands release PTH in response to decreased serum calcium and increased serum phosphorus levels. The actions of PTH include ... 

All of these actions are directed at increasing serum calcium levels and decreasing serum phosphorus levels, although the activity of calcitriol also increases phosphorus absorption in the GI tract and mobilization from the bone, which can worsen hyperphosphatemia. Calcitriol also decreases PTH levels through a negative feedback loop. These measures are sufficient to correct serum calcium levels in the earlier stages of CKD. 

As kidney function continues to decline and the GFR falls less than 60 mL/minute/1.73 m2, phosphorus excretion continues to decrease and calcitriol production decreases, causing PTH levels to begin to rise significantly, leading to secondary hyperparathyroidism (sHPT). The excessive production of PTH leads to hyperplasia of the parathyroid glands, which decreases the sensitivity of the parathyroid glands to serum calcium levels and calcitriol feedback, further promoting sHPT. 

Increased serum phosphorus levels Low to normal serum calcium levels Increased Ca-P product Increased PTH levels Decreased vitamin D levels... 

Parathyroidectomy is a treatment of last resort for sHPT, but should be considered in patients with persistently elevated iPTH levels above 800 pg/mL (800 ng/L) that is refractory to medical therapy to lower serum calcium and/or phosphorus levels.39 A portion or all of the parathyroid tissue may be removed, and in some cases a portion of the parathyroid tissue may be transplanted into another site, usually the forearm. Bone turnover can be disrupted in patients undergoing parathyroidectomy whereby bone production outweighs bone resorption. The syndrome, known as hungry bone syndrome, is characterized by excessive uptake of calcium, phosphorus, and magnesium for bone production, leading to hypocalcemia, hypophosphatemia, and hypomagnesemia. Serum ionized calcium levels should be monitored frequently (every 4 to 6 hours for the first 48 to 72 hours) in patients receiving a parathyroidectomy. Calcium supplementation is usually necessary, administered IV initially, then orally (with vitamin D supplementation) once normal calcium levels are attained for several weeks to months after the procedure. 

Phosphate-Binding Agents When serum phosphorus levels cannot be controlled by restriction of dietary intake, phosphate-binding agents are used to bind dietary phosphate in the GI tract to form an insoluble complex that is excreted in the feces. Phosphorus absorption is decreased, thereby... 

Pharmacologic therapy with sodium bicarbonate or citrate/citric acid preparations maybe needed in patients with stage 3 CKD or higher to replenish body stores of bicarbonate. Calcium carbonate and calcium acetate, used to bind phosphorus in sHPT, also aid in increasing serum bicarbonate levels, in conjunction with other agents. 

Calcitonin is a polypeptide hormone that (along with PTH and the vitamin D derivative, 1,25-dihydroxycholecalciferol) plays a central role in regulating serum ionized calcium (Ca2+) and inorganic phosphate (Pi) levels. The adult human body contains up to 2 kg of calcium, of which 98 per cent is present in the skeleton (i.e. bone). Up to 85 per cent of the 1 kg of phosphorus present in the body is also found in the skeleton (the so-called mineral fraction of bone is largely composed of Ca3(P04)2, which acts as a body reservoir for both calcium and phosphorus). Calcium concentrations in human serum approximate to 0.1 mg ml-1 and are regulated very tightly (serum phosphate levels are more variable). 

The rat has been used rather widely to study the relation between dietary protein, or acid salt feeding, and calcium loss. Barzel and Jowsey (19) showed that the rat fed a control diet supplemented with ammonium chloride excreted excessive urinary calcium, and experienced a concomitant loss of fat-free bone tissue. Draper, et al. (20) extending this work, reported an inverse relation between dietary phosphate and loss of bone calcium and dry, fat-free tissue. In subsequent studies (21), they reported that this process was accompanied by reduced serum calcium levels the high phosphorus, low calcium diet increased urinary calcium loss. Whereas, increasing the phosphorus content of the diet stopped the excessive urinary calcium loss. To test possible zinc loss that might result from this sort of acid salt feeding, Jacob and her coworkers (22) fed rats a supplement of ammonium chloride and then measured urinary zinc and calcium. The hypercalciuria occurred exclusive of an effect upon urinary zinc loss. 

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