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The plasma total calcium concentration is in the range of 2.2–2.6 mmol/L (9–10.5 mg/dL), and the normal ionized calcium is 1.3–1.5 mmol/L (4.5–5.6 mg/dL). [4] The amount of total calcium in the blood varies with the level of plasma albumin, the most abundant protein in plasma, and therefore the main carrier of protein-bound calcium in the blood.
Hyperparathyroidism is the state in which there is excess parathyroid hormone circulating in the blood. This may cause bone pain and tenderness, due to increased bone resorption. With increased circulating calcium, there may be other symptoms associated with hypercalcemia, most commonly dehydration.
The secretion of parathyroid hormone (PTH) is regulated by the interaction of the calcium-sensing receptor with calcium in the blood. The calcium-sensing receptor is present on the plasma membrane of the chief cells. The CaR is a G protein-coupled receptor, as part of the C family. The CaR is divided into three general domains.
A diagrammatic representation of the movements of calcium ions into and out of the blood plasma (the central square labeled PLASMA Ca 2+) in an adult in calcium balance: The widths of the red arrows indicating movement into and out of the plasma are roughly in proportion to the daily amounts of calcium moved in the indicated directions.
Calcium homeostasis. The plasma ionized calcium (Ca 2+) concentration is very tightly controlled by a pair of homeostatic mechanisms. [61] The sensor for the first one is situated in the parathyroid glands, where the chief cells sense the Ca 2+ level by means of specialized calcium receptors in their membranes.
Calcitonin lowers blood levels of calcium by inhibiting the resorption of bone by osteoclasts, and its secretion is increased proportionally with the concentration of calcium. [ 7 ] Parafollicular cells are also known to secrete in smaller quantities several neuroendocrine peptides such as serotonin , somatostatin or CGRP .
T-tubules (transverse tubules) are extensions of the cell membrane that penetrate into the center of skeletal and cardiac muscle cells.With membranes that contain large concentrations of ion channels, transporters, and pumps, T-tubules permit rapid transmission of the action potential into the cell, and also play an important role in regulating cellular calcium concentration.
The US Institute of Medicine (IOM) established Recommended Dietary Allowances (RDAs) for calcium in 1997 and updated those values in 2011. [6] See table. The European Food Safety Authority (EFSA) uses the term Population Reference Intake (PRIs) instead of RDAs and sets slightly different numbers: ages 4–10 800 mg, ages 11–17 1150 mg, ages 18–24 1000 mg, and >25 years 950 mg. [10]