calcio (2)
TRANSCRIPT
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DISTRIBUCIÓN Y FUNCIONES DEL CALCIO Y DEL FÓSFORO EN EL ORGANISMO
HOMEOSTASIS PLASMÁTICA DEL CALCIO Y DEL FÓSFORO
- Absorción intestinal- Excreción urinaria- Intercambio óseo
HORMONAS CALCIOTRÓPICAS- Hormona Paratiroidea- Vitamina D- Calcitonina- Otras
ACCIÓN HORMONAL INTEGRADA Y FISIOPATOLOGÍA DE LA HOMEOSTASIS DEL CALCIO Y DEL FOSFATO
AJUSTES HOMEOSTÁTICOS DURANTE PERIODOS DE DEMANDA INCREMENTADA DE CALCIO Y DE FÓSFORO
- Gestación- Lactación- Formación de la cáscara del huevo
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DISTRIBUCIÓN ORGÁNICA DEL CALCIO Y DEL FÓSFORO
Ca 2+
<1 %
Ca 2+ Extracelular
<1 %Ca 2+
TEJIDOS BLANDOS
Ca 2+ Intracelular (2º mensajero)
HPO4 2-
<1 %
15 %
FosfolípidosFosfoproteínasÁcidos nucleicosEnzimasCofactoresNucleótidos
HPO42-
Ca 2+
99 %
85 %HPO4
2-
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PLASMACalcio (10 mg/dl)
Calcio 30-50%
Calcio 6-10%
Calcio (Ca2+) 40% (1.17-1.33 mM)
FRACCIÓN DIFUSIBLEFRACCIÓN DIFUSIBLE
FRACCIÓN NO IÓNICAFRACCIÓN NO IÓNICAFRACCIÓN IONIZADAFRACCIÓN IONIZADA
Fósforo (3.5-5.5mg/dl
)
FRACCIÓN UNIDA A PROTEÍNAS (NO DIFUSIBLE)
FRACCIÓN UNIDA A PROTEÍNAS (NO DIFUSIBLE)
Fósforo 12%
Fósforo 34%
Fósforo 54% HPO4
2- (44%) H2PO4
- (10%)
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[ Ca2+ ] [ HPO42- ]XX = =
ctecte
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PTH CT
Vitamina D
Ca 2+
HPO4 2-
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Ca 2+
HPO4 2-
TEJIDOS BLANDOS
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[Ca2+] intraluminal
Fluj
o tr
anse
pite
lial
Ca 2+ Ca 2+
Vitamina D
Ca 2+
Ca 2+
Ca 2+
Ca 2+ Ca 2+
Ca 2+
ABSORCIÓN (20-70%)
Ca 2+ Ca 2+ Ca 2+
INGESTA
HECES
Ca 2+Ca 2+
Na +
Na +
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+
+ +
+
++
+
++
++
+
+++ +
+
++
+
Vitamina D
HPOHPO4422--
HPOHPO442-2-
HPOHPO442-2-
2 Na2 Na++
HPOHPO442-2-
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HPO42-
20%
Ca 2+
60%
Ca 2+
25%
Ca 2+
8-10%
HPO42-
75%
HPO42-
HPO42-
Ca 2+
1-3%
PTH
PTH
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OSTEOCITOS
OSTEOBLASTOS
OSTEOCLASTOS
CaHPO4
Ca10(PO4)6(OH)2
HPO42-
Ca 2+
HPO42-Ca 2+
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PLASMA
MATRIZ ÓSEA
OSTEOBLASTO
OSTEOCITO
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H+
H+H+
H+
H+
N
N
N
N
N
Ca 2+
HPO42-
Hidroxiprolina
Líquido extracelular
HUESO
Zona de resorción
ósea
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Arteria carótida común
Timo
Tronco bicarotídeo
Primera costilla
PARATIROIDES EXTERNAS
PARATIROIDES INTERNAS
PARATIROIDES EXTERNAS
PARATIROIDES INTERNAS
PARATIROIDES
PARATIROIDES SUPERIORES
PARATIROIDES INFERIORES
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Humana Bovina Porcina
20
40 60
80
QQQ
LLL
LLL
VVV
VVV
EEE
HHH
KKK
KKK
RRR
WWW
DDD
SSS
EEE
LLL
EEE
SAS
VVV
SSS
III
QQQ
LLL
LFL
MMM
HHH
NNN
MML
HHH
GGG
KKK
RRR
NSN
FFF
NNN
VVV
AAA
LLL
GGG
AAA
PSP
LFL
AAV
PYH
RRR
DDD
AGA
GSG
SSS
QQQ
RRR
RRR
KKK
KKK
EEE
NNN
VVV
LLL
EEE
SSS
EQE
SSS
LLL
HHH
VVV
DDD
PPP
LLL
GGG
EEE
AAA
DDD
KKK
AAA
DDA
VVV
NDD
VVV
LLL
TIT
KKK
AAA
KKK
QQQ
SPS
HORMONA PARATIROIDEAHORMONA PARATIROIDEA
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NÚCLEO
MITOCONDRIA
GOLGI
LISOSOMA
RETÍCULO ENDOPLÁSMICO RUGOSO
1-2 min1-2 min 15-20 min15-20 min 30 min30 min
ADN
ARNm
PreProPreProPTHPTH
ATP
PTHPTH
ProProPTHPTHPTHPTHPTHPTH PTHPTH
GRÁNULOS SECRETORESGRÁNULOS SECRETORES
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100
80
60
40
20
1 2 3[Ca2+ plasmático] (mM)
Sec
reci
ón P
TH
(%
máx
imo)
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Ca 2+
PTH
HPO42-
PTH
Aminoácidos
HCO3- K+
PTH
PTH
Vitamina D
![Page 24: Calcio (2)](https://reader038.vdocuments.com.br/reader038/viewer/2022102706/55c07735bb61ebe1248b47b1/html5/thumbnails/24.jpg)
OsteocitoOsteocito
Osteoblasto
Matriz Ósea
Fluido extracelular
Osteoclasto
Matriz Ósea
Osteoblasto
PTH
PTH
Monocito
Matriz Ósea
Osteoclasto
Osteoblasto
Ca Ca 2+2+Ca Ca 2+2+
Ca Ca 2+2+
PTH
PTH
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PTH
Ca 2+
Ca 2+
Ca 2+
Vitamina D
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Ca 2+
HPO4 2-
PTH
Ca 2+
HPO4 2-
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7-Dehidrocolesterol
Provitamina D3
Vitamina D3 Trans
calciferina
Vitamina D3 (Colecalciferol)
25-OH-D325-hidroxilasa
Vitamina D2 (Ergocalciferol)
Vitamina D3 (colecalciferol)
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25-OH -D3
1,25-(OH) 2 -D3
(calcitriol)
24,25-(OH)24,25-(OH) 2 2 -D-D33
GH Estrógenos Prolactina
Calcitonina PTH
Hipocalcemia
Hipofosfatemia
Vitamina D
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DUODENO YEYUNO
ARNm
CaBP
Ca 2+CaBP
D
D
D
D
ARNm
Na+HPO4
2-
D
D
D
D
ARNmCa 2+
Ca 2+
ARNm
Ca 2+
Ca 2+-ATPasa
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Osteoclasto
Osteoblasto
Osteoblasto (precursor)
Monoblasto
Linfocito T
Monocito Macrófago
INTERLEUCINAS
FACTORES DE CRECIMIENTO
PTHVitamina D
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Vitamina D
Ca 2+ Ca 2+
HPO4 2- HPO4
2-
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TIROIDES
PARATIROIDES
ARTERIA CARÓTIDA
CORAZÓN
TIROIDES
PARATIROIDES
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CTCT
Núcleo
RER
AG
Pre-pro-CTPre-pro-CT
ARNm
CTCTPro-CTPro-CT
CTCT
CTCT CTCT
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CALCIO PLASMÁTICO
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Vitamina D
CALCITONINA
CÉLULA C
Estrógenos
Hormonas Gastrointestinales
Ca 2+
Ca 2+ plasmático
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AMPc
CT
CT
HPO4 2-
Ca 2+
Ca 2+
CT HPO4 2-
HPO4 2-
Ca 2+
HPO4 2-
Ca 2+
25-OH-D3
Vitamina D
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Ca 2+ HPO4 2-
CT
PTH
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HIPERCALCEMIANTE Absorción intestinal Resorción ósea
HIPOCALCEMIANTE
Absorción intestinal
HIPERFOSFATÚRICA
FORMACIÓN HUESO
HIPERCALCEMIANTE
Síntesis vitamina D
Proteínas plasmáticas
RESORCIÓN ÓSEA
HIPERCALCEMIANTE
Absorción intestinal
SÍNTESIS HUESO
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Ca 2+
HPO4 2-
PTH
ACCIÓN INSTANTÁNEA
Vitamina D
HORAS O DIAS
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Ca 2+
Ca 2+ Ca 2+
PTH
HPO4 2-HPO4
2-
HPO4 2-
Vitamina D
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Ingesta Ca 2+
REABSORCIÓNRENAL
MOVILIZACIÓNÓSEA
ABSORCIÓNINTESTINAL
10-25%
75-90%
% AmortiguaciónPTH
Ca 2+ Plasmático
Vitamina D
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PTH
Vitamina D
Ca 2+
PO4 2-
PO4 2-
Ca 2+
Ca 2+ Plasmático Acidosis
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PTH
Ca 2+Ca 2+
Ca 2+ Plasmático
CT
10.5 mg / dl
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PO4 2-
PO4 2-
Ingesta de PO4 2-
PO4 2- Plasmático
Ca 2+ Plasmático
PTH
Vitamina D
EFECTO NO HOMEOSTÁTICO
Ca 2+
Ca 2+
EFECTOHOMEOSTÁTICO
![Page 53: Calcio (2)](https://reader038.vdocuments.com.br/reader038/viewer/2022102706/55c07735bb61ebe1248b47b1/html5/thumbnails/53.jpg)
Ingesta de PO4 2-
PTH
Ca 2+ Plasmático
PO4 2- Plasmático
PO4 2-
PO4 2-
Ca 2+
Ca 2+
MECANISMOHOMEOSTÁTICO MECANISMO
NO HOMEOSTÁTICO
Vitamina D
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Ca 2+
HPO4 2-
Ca 2+
Ca 2+
HPO4 2-
HPO4 2-
CT Estrógenos Prolactina
Calcitonina
25-OH-D3
PTH
Vitamina D
Vitamina D
25-OH-D3
![Page 57: Calcio (2)](https://reader038.vdocuments.com.br/reader038/viewer/2022102706/55c07735bb61ebe1248b47b1/html5/thumbnails/57.jpg)
PO4 2-
Ca 2+
Ca 2+
HPO4 2-
Vitamina D
Vitamina D
PTHCT
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CT
PTHVitamina D
PTH
Ca2+
HPO42-
Ca2+
PO42-
Vitamina D
CT
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HPO42- Ca2+
PTH
PTH
H+
HCO3
-HPO42-
H2PO4
-
Ca2+
Vitamina DCa2+
Buche
Duodeno
MollejaCa2+
Hueso Medular
Hígado
Útero Ovario
Riñón
Vitamina D
25-OH-D3
CT
![Page 62: Calcio (2)](https://reader038.vdocuments.com.br/reader038/viewer/2022102706/55c07735bb61ebe1248b47b1/html5/thumbnails/62.jpg)
PTH CT
Vitamina D
Ca 2+
HPO4 2-