Trace elements

1. Trace Elements
Dr Manjuprasad
Moderater:Dr Ravichandra V
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2. Overview
• Introduction
• Classification
• Individual trace elements
• conclusion
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3. Introduction
• Naturally occurring, homogeneous, inorganic
substance required in humans in amounts less
than 100 mg/day
• Minerals for 5% of our diet
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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
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6. Iron
• Most essential trace element
• Body content – 4-6g
Hb – 68%
ferritin – 13 %
haemosiderin – 12%
myoglobin – 3%
iron enzymes – 0.2%
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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)
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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
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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
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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
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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
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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
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14. • Parenteral preparations:
Iron dextran
Iron sorbitol citric acid complex
• Adverse effects:
Pain at injection site, pigmentation
Fever, headache, palpitations, anaphylaxis
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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
• Desferrioxamine 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
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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
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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
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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
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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
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21. Copper
• 3rd most important trace element
• Diet rich in copper: red meat, shell fish, water
pumped through copper pipes
• Body content of copper is 80-120mg
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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
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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
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24. • Toxic – 5mg/kg
• Adequate – 34mcg/kg
• Deficient - <8.5mcg/kg
• RDA – 09 - 1.3mg/day
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25. Deficiency symptoms:
• Fragile hair
• Depigmented skin
• Myeloneuropathy
• Edema
• Hepatosplenomegaly
• Osteoporosis
• Anemia, neutropenia
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26. Menkes disease
• Congenital X-linked genetic disorder
• Mutation in ATP7A gene
• Inactivating mutation in this gene causes Cu
deficiency
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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
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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
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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
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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
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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)
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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 ).
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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
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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
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36. • Biological role: manganese superoxide dismutase
arginase, glutamate synthase & pyruvate
carboxylase
• Deficiency :
Experimental animals - ↓growth, ↓fertility, ataxia,
skeletal deformities, abnormal fat and CHO
metabolism
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37. • Toxicity:
Neurotoxic- extrapyramidal parts affected
Headache
Hepatic dysfunction
• RDA – 2-11mg/day
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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
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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.
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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
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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
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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
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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
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45. Lithium
• Discovered in 1817 as mood stabilizing agent
MOA:
• Inositol depletion theory
• Inhibition of NMDA receptor mediated signalling
• Inhibition of GSK3
• BDNF upregulation
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46. Adverse effects:
• Nephrogenic diabetes insipidus
• Thyroid function abnormalities
• mental confusion
• hyperreflexia
• gross tremor
• dysarthria
• Seizures
• cardiac arrhythmias,
• hypotension, and
• albuminuria.
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47. Uses
• BPD
• Mania
• Depression
• Cancer induced leukopenia & agranulocytosis
Preparation:
• Lithium carbonate 150/300/600mg
• Lithium citrate syrup 8mEq/5ml
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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
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49. Bibliography
• Pharmacological aspects of therapeutics – Goodman and Gilman –
12th edition
• Textbook of medical pharmacology – Dr.PadmajaUdaykumar – third
edition
• Katzung BG, Masters SB, Trevor AJ. Basic and Clinical
Pharmacology.12th 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.
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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.
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