Biochemistry and Clinical Pathology Water and Mineral Metabolism

MINERALS
Minerals are the inorganic elements present in living organism. Though they constitute a very small
portion of body weight, they are essential for many vital processes of body. Based on the dietary
requirement, they are classified into two groups;
Principal mineral elements (Macronutrients): These are the minerals having more than 100 mg daily
requirement. They include Sodium, Potassium, Chlorine, Calcium, Magnesium, Phosphorus and
Sulphur.
Essential trace elements (Micronutrients): These are the minerals having less than 100mg daily
requirement. They include Iron, Iodine, Copper, Zinc, Cobalt, Manganese, Molybdenum,
Selenium, Chromium and Fluorine.
SODIUM: Sodium is one of the most abundant elements present in body. Healthy human body contains
about 1.8 g/kg body weight of sodium. It is major cation of extra cellular fluid.
Daily requirement: Daily requirement for sodium is around 3-5 gm for normal adult.
Dietary source: Some good dietary sources of sodium include table salt milk, baking powder meat and
some vegetables.
Physiological functions:
1. Sodium ions play major role in maintenance of osmotic pressure.
2. In association with chloride, bicarbonate and phosphate ions it regulates the
physiological acid base balance.
3. It plays important role in preserving irritability of muscle and permeability of
cells.
4. Sodium also plays important role in conduction of nerve impulse.
5. It helps in retention of water in body fluids and thus prevents excess fluid loss.
6. Sodium is also involved in absorption of glucose and amino acids from small
intestine.
Disorders: The normal level of sodium in plasma is 173 mEq/L. In Hypernatremia the level of sodium
in plasma rises above normal. It may be due to hyperactivity of Adrenal cortex (Cushing's
syndrome), Diabetes insipidus etc.
A decrease in plasma sodium concentration (Hyponatremia as in Adison's disease, is associated
with adrenocortical insufficiency or chronic renal diseases.

POTASSIUM: Potassium is a major cation of intracellular fluid. Healthy human body contains about 2.6
gm/ Kg body weight of potassium.
Daily requirement: Daily requirement for potassium ranges between 1.5-4.5 gm for normal adult.
Dietary source: Banana, chicken, beaf, liver, potato etc are good dietary sources of potassium.
Physiological functions:
1. Potassium ions play a critical role in muscle contraction particularly cardiac
muscle.
2. Potassium plays important role in maintenance of osmotic pressure of body
fluids.
3. It helps in retention of water in body fluids and thus prevents excess loss of fluids.
4. Potassium also helps in maintenance of physiological acid base balance.
5. It acts as cofactor for certain enzymes like Pyruvate kinase of glycolytic pathway.
Disorders: The normal level of potassium in plasma is 5 mEq/L. In Addison's disease, renal failure,
advance dehydration or shock, the plasma level of potassium rises (Hyperkalemia) which is leads
to bradycardia, cardiac arrest, confusion, weakness, numbness of extremities etc. In chronic
wasting, malnutrition, diarrhea etc. the plasma potassium level decreases (hypokalemia) which
leads to tachycardia, muscle weakness, irritability and paralysis.
CHLORINE: Chlorine is present in the form of chlorides in body fluids. It is the major anion present in
plasma and interstitial fluids.

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Biochemistry and Clinical Pathology Water and Mineral Metabolism
Daily requirement: Daily requirement for chloride for healthy adult is 2 - 5 gm in the form of table
salt.
Dietary source: Table salt
Physiological functions:
1. Chlorides along with sodium play important role in maintenance of osmotic pressure of body
fluids.
2. Along with sodium and bicarbonate chlorides helps in maintenance of physiological acid base
balance.
3. Along with sodium it plays important role in retention of water in body.
4. It is required for production of hydrochloric acid in stomach.
5. It acts as activator for amylase enzyme.
Disorders: Chloride deficiency occurs when loss of sodium is excess as in diarrhea, excessive sweating
and certain endocrinal disorders. In severe vomiting and duodenal obstruction also there is loss of
chlorides in gastric juice. In Cushing’s syndrome, due to decrease in chloride, hypochloremic
alkalosis may occur.
CALCIUM: Calcium is essential trace element present in body. Body contains an average of 22g/Kg body
weight of calcium. More than 90% of this calcium is present in bones and teeth in the form of
calcium carbonate and phosphate. The remaining calcium is present in extracellular fluid (ECF) as
soluble salts and in combination with some proteins. The different forms of calcium are in
equilibrium.
Daily requirement: Daily requirement for calcium in healthy adult males and females is 800 mg. In
lactating mothers, the requirement is 1.2 g. In children the requirement is 0.8 to 1.2 g while in
infants it is 400 to 600 mg.
Dietary source: Milk and milk products are the richest source of calcium. Other good dietary sources
of calcium are eggs, nuts, figs, cabbage and cauliflower etc.
Physiological functions:
1. Calcium is essential for normal functioning of autonomic nervous system.
2. It is an important factor in coagulation of blood.
3. It is required for normal functioning of skeletal and cardiac muscles.
4. It is required for normal growth and development of bones.
5. It plays important role in production and release of several hormones.
Absorption: Calcium is absorbed in the acidic medium of duodenum and proximal jejunum.
Calmodulin, a calcium binding protein which is synthesised in response to Vitamin D3, and
phosphates promote absorption of calcium from intestine. Growth hormone and Parathyroid
hormones also increase intestinal absorption of calcium. Phytic acid and oxalates in diet decrease
absorption of calcium by forming insoluble salts.
Disorders: Decreased calcium availability leads to deficiency of calcium characterized by
Hypocalcemia – a state of electrolyte imbalance in which the level of calcium in blood decreases
below normal. Prolonged hypocalcemia leads to leaching of calcium from bones to restore the
equilibrium. This leads to Osteomalasia in adults and Rickets in children. Calcium deficiency in
new born may lead to neonatal tetany.
MAGNECIUM: Healthy adults contain about 21g of magnesium most of which is present in bones in
combination with calcium and phosphorous. Magnesium is the principle cation of soft tissues.
Daily requirement: Daily requirement for calcium in healthy adult males and females is 200 - 300 mg.
In children the requirement is 150 - 200 mg while in infants it is 100 - 150mg.
Dietary source: Milk and milk products, fruits, nuts cabbage, cauliflower etc. are good dietary sources
of magnesium.
Physiological functions:
1. Magnesium constitutes the mineral part of bones.
2. It plays important role is activator for many phosphate transfer enzymes.
3. It is a component of cocarboxylase enzyme.

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Biochemistry and Clinical Pathology Water and Mineral Metabolism
4. It acts as a cofactor for oxidative phosphorylation.
Disorders: Magnesium deficiency can arise from excessive loss due to diarrhea or prolonged diuresis,
renal diseases or hyperthyroidism. Its deficiency causes depression, muscle weakness, virtigo and
liability to convulsions.
PHOSPHOROUS: Most of the phosphrous present in human body is combined with calcium in bones and
teeth. Every cell contains phosphorous the form of free phosphate ions and organic phosphates.
Daily requirement: Daily requirement for phosphorous in healthy adult males and females is 800 mg.
In lactating mothers the daily requirement is 1.2 g. In children the requirement is 0.8 - 1.2g while
in infants it is 250 - 500mg.
Dietary source: Milk and milk products, eggs, meat, fish and nuts are good dietary sources of
phosphorous.
Physiological functions:
1. Phosphorous, along with calcium, is essential for formation of bones and teeth.
2. It is required for the formation of phospholipids, nucleic acid and phosphoproteins.
3. It is required for the storage of energy in the form of Adenosine triphosphate (ATP) and creatinine
phosphate.
4. In the form of phosphate buffer system, phosphorous plays important role in regulation of
physiological acid base balance.
5. It forms coenzymes such as NADP, ADP and AMP etc.
Disorders: In hypoparathyroidism and severe renal diseases, the level of phosphates in plasma
increases (hyperphosphatemia) which leads to acidosis. In hyperparathyroidism, the level of
phosphates in plasma decreases (hypophosphatemia).
SULPHUR: Human body contains about 150 - 200 g of sulphur most of which is present in sulphur
containing amino acids cystein and methionine. A small amount is also present as sulphate ions in
the body fluids.
Dietary source: Sulphur intake is mainly in the form of cystein and methionine present in proteins.
Meat, eggs, liver, fish legumes and cereals are rich in proteins having cystein and methionine.
Physiological functions:
1. Sulphur containing amino acids ie. Cystein and methionine are important
constituents of body proteins like keratin and other biomolecules like chondroproteins, mucopoly-
saccharides and sulpholipids.
2. Sulphur in the form of active sulphate participates in transulphuration reactions.
3. Sulphur containing amino acid methionine as S- adenosyl methionine is an active
methyl donor and is required for synthesis of large number of methylated compounds in body.
4. Sulphur is a constituent of Coenzyme A and lipoic acid.
Disorders: In impaired renal function, leukemia and intestinal obstructions, the serum sulphate levels
are increased which cause acidosis.
IRON: Total iron content of normal adult is 4 - 5 gm. About 60 - 70% of total iron is present in
hemoglobin, 3% in myoglobin, 0.1% as transferrin in plasma and remaining is stored in the form
of ferritin in liver, spleen, bone marrow, kidney etc.
Dietary requirement: Healthy adult males and elderly women aged above 50 require 10 mg iron per
day. Growing children and women below age 50 require 80 mg iron per day while infants require
10 - 15 mg iron per day.
Dietary source: Liver, heart, kidney and spleen are rich sources of iron. Eggs, figs, nuts, dates and
spinach too are good dietary sources of iron.
Absorption: (Mucosal block theory) Iron is absorbed in the acidic medium of duodenum and proximal
jejunum. Only a small portion of the dietary iron (less than 10%) is absorbed. The iron present in
the diet is in the less soluble and poorly absorbable ferric (Fe +3) form. Glutathione and ascorbic
acid etc. reduce it to ferrous state (Fe +2) which is water soluble and well absorbed. The ferrous
ions enter mucosal cells of intestine where they are oxidized to ferric state and bound to

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Biochemistry and Clinical Pathology Water and Mineral Metabolism
apoferritin to form ferritin. Elevated levels of ferritin in mucosal cells inhibit further absorption of
iron. It is called mucosal block of iron absorption. The mucosal cells release iron into portal blood
as ferrous ions which are reduced to ferric state by ceruloplasmin. The ferric ions bind with
transferrin and are transported to liver, kidney, bone marrow etc. for storage.
Physiological functions:
1. The main role of iron in body is in the transport of oxygen as hemoglobin.
2. It is also involved in cellular respiration.
3. It is essential component of hemoglobin, myoglobin, cytochromes and respiratory
enzymes.
4. It is essential for redox enzymes like Catalase, Peroxidase etc.
Disorders: Iron deficiency leads to anemia. It is widely prevalent among children, adolescent girls and
nursing mothers. Inadequate dietary supplementation, impaired absorption and hemorrhagic
losses are the common causes of iron deficiency anemia. The hemoglobin content of blood falls to
5 - 9gm per 100ml. The symptoms are breathlessness on exertion, giddiness and pallor of skin.
Iron compounds like ferrous sulphate, ferrous ammonium citrate, ferrous gluconate etc. are given
for treatment of iron deficiency anemia.
IODINE: Total iodine content of normal adult is 10- 12mg. About 80% of total iodine is present in thyroid
gland.
Dietary requirement: Healthy adult require 150 micro gm/ day of iodine. Children require 70 - 120
micro gm iodine per day while infants require 40 - 50 micro gm iodine daily.
Dietary source: Iodised salts, sea food and marine vegetation are rich sources of iodine.
Physiological functions:
Iodine is required for the biosynthesis of thyroid hormones thyroxin (T4) and triiodo thyronine
(T3). These thyroid hormones are involved in cellular oxidation, growth, reproduction and the
activity of central and autonomic nervous systems. Triiodo thyronine is more active than thyroxin.
Disorders: Deficiency of iodine leads to Goiter characterized by enlargement of thyroid gland. In
children prolonged deficiency of iodine leads to retarded growth leading to cretenism.
COPPER: Normal adult contain 100- 150 mg copper which are distributed primarily in muscles (about 60
%), bones (about 20%) and liver (about 15%). RBC contains a colourless copper protein
erythrocuprein while plasma contains a blue coloured copper protein ceruloplasmin.
Dietary requirement: Healthy adult require 1.5 - 3 mg copper per day. Children require 0.7 - 2.5 mg
copper per day while infants require 0.40 - 0.7mg copper daily.
Dietary source: Liver is rich sources of copper. Meat, nuts, legumes and cereals are also good sources
of copper.
Physiological functions:
1. Copper has important role in biosynthesis of hemoglobin.
2. It is required for synthesis of melanin, phospholipids and collagen.
3. It has role in bone formation and maintenance and integrity of myelin sheath.
4. It is a constituent of several enzymes such as tyrosinase, cytochrome oxidase, ceruloplasmin etc.
Disorders: Deficiency of copper leads to iron deficiency anemia due to decreased activity of
ceruloplasmin. Copper deficiency causes marked skeletal changes, osteoporosis and spontaneous
fractures. In experimental animals copper deficiency causes weight loss and death.
Wilson's disease is a rare hereditary disorder of copper metabolism in which level of copper in
plasma increases drastically. The excess plasma copper is deposited in brain, liver and kidney. It
leads to hepatic cirrhosis and renal tubular damage.
ZINC: Total zinc content of adult is 2g. It is present in muscles, pancreas, leukocytes, nails and hair.
Dietary requirement: Healthy adult require 15 mg zinc per day. Children require 10 mg zinc per day
while infants require 5 mg zinc daily.
Dietary source: Liver, milk and milk products, eggs, cereals, nuts and legumes are good dietary
sources of zinc.

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Biochemistry and Clinical Pathology Water and Mineral Metabolism
Physiological functions:
1. Zinc is essential constituent of many enzymes such as carboxy peptidase, carbonic
anhydrase, alkaline phosphatase, superoxide dismutase etc.
2. It is a constituent of retinene reductase which is required for formation of
retinene.
3. It mobilizes vitamin A from liver and maintains normal concentration of vitamin A
in plasma.
4. It is required for polymerisation of insulin.
5. It is also involved in wound healing.
6. It is essential for normal growth and reproduction of animals.
Disorders: Deficiency of zinc leads to poor wound healing, lesions of skin, growth failure, dwarfism,
hypogonadism, impaired spermatogenesis and lack of taste acuity. Prolonged deficiency causes
hepatospleenomegaly, delayed closure of epiphyses of long bones and anemia.
COBALT: Total cobalt content of adult is about 1.5 mg. It forms an integral part of vitamin B 12.
Dietary requirement: The cobalt contained in 1 - 2 micro gram of vitamin B12 is sufficient for daily
requirement of cobalt in adults.
Dietary source: Cobalt is widely distributed in most common foods in the form of vitamin B 12.
Physiological functions:
1. Cobalt is essential component of vitamin B12 which is necessary for normal red
blood cell formation.
2. It is required to maintain normal bone marrow function and for development and
maturation of RBCs.
3. Certain enzymes such as methyl malonyl CoA mutase, methyl tetrahydro folate
oxido reductase, etc. require cobalt in the form of vitamin B 12.
Disorders: Deficiency of cobalt leads to microcytic anemia, anorexia, fatty liver, wasting and
hemosiderosis of spleen.