Trace Elements and their deficiencies

1. TRACE ELEMENTS
AND
THEIR DEFICIENCY
Monika U
18BCHA12

2. OVERVIEW
❖Introduction
❖Classification
❖Trace Elements and their deficiencies
❖Summary

3. INTRODUCTION
• Naturally occurring, homogeneous, inorganic
substance required in humans in amounts less
than 100 mcg/day
• Constituents of living organisms, and are necessary
for their growth, development, and health.
3

4. CLASSIFICATION
4
• Essential trace elements
Iron, Zinc, Copper, Co, Cr, fluoride, Iodine,
Manganese, Molybdenum and Selenium
• Probably essential trace elements
Nickel, Tin, Vanadium, Si, Bo
• Non essential trace elements
Aluminium, Gold, Barium, Br, lead, silver, mercury,
rubidium, strontium, titanium, zirconium,

5. ESSENTIAL TRACE ELEMENTS
5
• Trace elements
Iron, zinc and copper
• Ultra trace elements
Manganese, selenium, cobalt,
chromium, fluoride, iodine, and molybdenum

6. IRON
6
• Most essential trace element
• Iron is essential for the delivery of oxygen to cells.
• Body content – 4 - 6g
• Hb – 68%
• Ferritin – 13 %
• Myoglobin – 3%
• Iron enzymes – 0.2%

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 menstrual cycle)
7

8. • DIETARY SOURCES :
Leafy greens, whole grains, beans , pulses,
liver, spleen, mollusks
• Iron is absorbed in ferrous
form, which is measurable
in blood as free iron
8

9. 9

10. • Oral preparations of iron:
Ferrous sulphate
Ferrous fumarate
Ferrous gluconate
Ferrous succinate Iron
Calcium complex
Ferric Ammonium
citrate
Adverse effects : Epigastric pain, nausea, vomiting,
gastritis, metallic taste, constipation or diarrhoea and10

11. • Parenteral preparations:
Iron dextran
Iron sorbitol citric acid complex
• Adverse effects:
Pain at injection site, pigmentation
Fever, headache, palpitations,
anaphylaxis
11

12. IRON DEFICIENCY
● When iron is deficient, Hb cannot be produced.
● Insufficient Hb leads to microcytic and hypochromic red
blood cells.
● Unable to deliver sufficient oxygen to the tissues.
● This is known as Iron Deficiency Anemia.
● Estimation : 80% of world population may be Iron
deficient and 30% may suffer from Iron deficiency
anemia
● Iron deficiency affects about 15% of the worldwide
population.

13. Those with higher than average risk of iron deficiency
anemia include pregnant women, young children and
adolescents, and women of reproductive age
Increased blood loss, decreased dietary iron intake,
or decreased release from ferritin may result in iron
deficiency.
Reduction in iron stores usually precedes both a
reduction in circulating iron and anemia, as demonstrated
by a decreased red blood cell count, mean corpuscular
hemoglobin concentration, and microcytic RBCs.
13

14. ● SYMPTOMS :
Asymptomatic
Weakness, headache, irritability, and varying
degrees of fatigue and exercise intolerance.
● TREATMENT :
3 - 6 mg of elemental iron / kg /day

15. IRON TOXICITY AND OVERLOAD
● Iron is essential for cellular metabolism, but too
much can be toxic.
● Iron Poisoning can be life-threatening.
● Can damage the intestinal lining and cause
abnormalities in body pH, shock and liver failure.
● Most common form of Iron overload is known as
hemochromatosis.
● Can happen over time and accumulates in
tissues like heart and the liver.

16. ● Primary Fe overload is most frequently associated
with hereditary hemochromatosis (HH).
● HH is a single-gene homozygous recessive disorder
leading to abnormally high Fe absorption, culminating
in Fe overload.
● Secondary Fe overload may result from excessive
dietary, medicinal, or transfusional Fe intake or be due
to metabolic dysfunction.
● HH causes tissue accumulation of iron, affects liver
function, and often leads to hyperpigmentation of the
skin.

17. ● Some conditions associated with severe
hemochromatosis include diabetes mellitus,
arthritis, cardiac arrhythmia or failure, cirrhosis,
hypothyroidism, impotence, and liver cancer.
TREATMENT
Treatment may include therapeutic phlebotomy
or administration of chelators, such as deferoxamine.
Transferrin can be administered in the case of
atransferrinemia.

18. Laboratory Evaluation of Iron
Disorders of iron metabolism are evaluated
primarily by packed cell volume, hemoglobin, red cell
count and indices, total iron and TIBC, percent
saturation, transferrin, and ferritin.
❖ Total Iron Content (Serum Iron)
Measurement of serum iron concentration refers
specifically to the Fe3 bound to transferrin and not
to the iron circulating as free hemoglobin in serum.
The specimen may be collected as serum without
anticoagulant or as plasma with heparin.

19. ❖ Total Iron-Binding Capacity
Total iron-binding capacity (TIBC) refers to the
amount of iron that could be bound by saturating
transferrin and other minor iron-binding proteins
present in the serum or plasma sample. Typically, about
one-third of the iron binding sites on transferrin are
saturated.
TIBC ranges from around 250 to 425 g/dL.
❖ Percent Saturation
The percent saturation, also called the transferrin
saturation, is the ratio of serum iron to TIBC. The normal
range for this is approximately 20% to 50%, but it varies
with age and sex.

20. Transferrin
20
• Transport protein
• Binds to two iron molecules
• Transports iron to various organs and tissues
• Determination of transferrin gives TIBC
(Total Iron Binding Capacity)
• Transferrin is increased in iron deficiency and
decreased in iron overload and hemochromatosis,
chronic infections and malignancies
• Transferrin can be measured by RIA, ELISA &
chemiluminescence

21. Ferritin
• A universal intracellular protein that stores
iron & releases it in a controlled fashion.
• Produced by almost all living organisms,
including algae, bacteria, higher plants, animals.
• In humans, it acts as a buffer against iron
deficiency and iron overload.
• Ferritin is decreased in iron-deficiency anemia
and increased in iron overload and
hemochromatosis, chronic infections,
malignancy, and viral hepatitis.
• IRMA (Immunoradiometric Assay), ELISA,
Chemiluminescence 21

22. ZINC
• Second most abundant trace element.
• Zinc (Zn) is a bluish white, lustrous metal.
• Zinc and its compounds are used in a production of
alloys, especially brass (with copper), in galvanizing
steel, in die casting, in paints, in skin lotions, in
treatment of Wilson’s disease, and in many
medications.
• Essential for growth and development.
• Involved in functioning of over 300 different
enzymes, including superoxide dismutase.
• Cofactor – DNA polymerase, Alkaline
phosphatase, Carboxypeptidase 22

23. REGULATION :
• Growth and Reproduction
• Immune system,
• Collagen synthesis,
• Wound healing,
• Bone metabolism,
• Taste, smell & vision
• Reduce the time period of diarrhea
• High dose of zinc prevents dysmenorrhea
• Zinc required in producing testosterone
• For common cold 23

24. • Body content - 2.5g
60% in muscle, 30% in bone, 10% in body tissues
and organs
• Daily requirement : 3 - 14 mg
• Diet rich in zinc : red meat, fish, sea food,
pumpkin, cashews, beans, dark chocolate
24

25. ZINC DEFICIENCY :
Causes growth retardation, slows skeletal
maturation, causes testicular atrophy, and
reduces taste perception.
Old age, pregnancy, lactation, and alcoholism are
also associated with poor zinc nutrition.
Leukemia, cirrhosis, hepatitis, sickle cell anemia,
Malnutrition 19

26. Zinc deficiency is also associated with
• Acrodermatitis enteropathica
• Anorexia
• Esophageal squamous cell carcinoma
• Cognitive and motor impairment
• Diarrhea and pneumonia
• In severe cases, lymphopenia may occur; death
follows an overwhelming infection.
26

27. SYMPTOMS :
In children- growth retardation &
skeletal abnormalities
In adults- ↓smell & taste, ↓appetite, skin
lesions, and hair loss
TREATMENT :
• Zinc supplements 45 – 100 mg/day

28. TOXICITY :
● Zinc is relatively nontoxic.
● Nevertheless, high doses (1 g) or repetitive doses of
100 mg/day for several months may lead to
disorders, especially gastrointestinal tract symptoms,
decrease in heme synthesis due to an induced copper
deficiency, and hyperglycemia.
● Exposure to ZnO fumes and dust may cause “zinc
fume fever.”
● The symptoms include chemically induced
pneumonia, severe pulmonary inflammation, fever,
hyperpnea, coughing, pains in legs and chest, and
vomiting.

29. REFERENCE INTERVALS FOR ZINC :
Zinc in serum: 70–120 g/dL
Zinc in urine of normal subjects: 140–800 g/24 hours
Zinc in urine of compliant patients on oral zinc therapy
for Wilson’s disease: 2,000 g/24 hours

30. COPPER
30
• Copper (Cu) is a relatively soft yet tough metal with
excellent electrical and heat conducting properties.
• Copper is widely distributed in nature.
• 3rd most important trace element
• Important in helping to prevent certain types of
anemia
• Richest dietary source : Organ meat
• Diet rich in copper: Red meat, shellfish, nuts,
chocolate, seafood, whole-grain foods.
• RDA – 1.3 - 1.5 mg/day

31. • An average day’s diet may contain 10 mg or more of
copper.
• The amount of copper absorbed from the intestine
is 50%–80% of ingested copper.
• About half of dietary copper is excreted in feces.
• The exact mechanisms by which copper is absorbed
and transported by the intestine are unknown
• Toxic – 5mg/kg
• Adequate – 34 mcg/kg
• Deficient - <8.5 mcg/kg
31

32. 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
32

33. DEFICIENCY :
● Copper deficiency is observed in premature infants.
● Copper deficiency is related to malnutrition,
malabsorption, chronic diarrhea, hyperalimentation,
and prolonged feeding with low-copper, total-milk
diets.
● Subclinical copper depletion contributes to an
increased risk of coronary heart disease.
● An extreme form of copper deficiency is seen in
Menkes disease

34. DEFICIENCY SYMPTOMS
• Fragile hair
• Depigmented skin
• Myeloneuropathy
• Edema
• Hepatosplenomegaly
• Osteoporosis
• Anemia, neutropenia
34

35. Menkes disease
• Congenital X-linked genetic disorder
• Mutation in genes coding for the copper-transport
protein ATP7A gene
• Causes Cu deficiency.
• Growth failure, kinky hair etc
35

36. Clinical forms :
• Include progressive mental deterioration
• Coarse feces
• Disturbance of muscle tone
• Seizures
• Severe hypothermia.
• Symptoms of Menkes disease usually appear at the
age of 3 months and death usually occurs in 5-year-
olds.

37. TOXICITY : Wilson's disease
• Hepatolenticular degeneration and progressive
lenticular degeneration,
• Autosomal recessive disorder
• Mutation in ATP7b gene
• Causes excessive accumulation of Cu.
• Wilson’s disease usually presents between the ages
of 6 and 40 years.
• Its manifestations include neurologic disorders,
liver dysfunction, and Kayser-Fleischer rings (green-
brown discoloration) in the cornea caused by
copper deposition. 37

38. • Early diagnosis of Wilson’s disease is important
because complications can be effectively
prevented and in some cases the disease can be
halted with use of zinc acetate or chelation
therapy.
( Chelation therapy is a medical procedure that
involves the administration of chelating agents to
remove heavy metals from the body )

39. CLINICAL FEATURES :
• Diarrhea, vomiting
• Cardiac & renal failure
• Hepatic necrosis
• Encephalopathy
TREATMENT :
• Life long treatment
• Avoidance of high Copper diet
• In early stages Zn may be effective as it competes
with Cu for absorption
• Penicillamine 39

40. REFERENCE INTERVALS OF COPPER :
● Copper in serum : 700–1500 g/L
● Mean levels for copper serum in women and children
are slightly 8–12% higher.
● Copper in serum (pregnancy at term) : 118–320 g/L
● Copper in urine : 15–60 g/24 hours or
3–35 g/24 hours or
2–80 g/L
● Copper in RBCs : 90–150 g/L

41. IODINE
• Soil near the ocean or sea is higher in iodine than
soil inland.
• More than half of the iodine is found in thyroid
gland
• Essential component for thyroid hormones ,
including thyroxine.
• Most of the iodine in the diet comes from iodized
salt.
• Natural sea salt has very low iodine.
32

43. • Iodine induced
hyperthyroidism :
- Multinodular
goiter, excess
iodine exposure
cause
hyperproduction
of thyroid
hormones and
clinically
significant
thyrotoxicosis.

44. Iodine induced
hypothyroidism:
• Large goiter can
cause a cough and
make it difficult for
you to swallow or
breathe.
• Within a goiter,
nodules can develop.
(HYPOTHYROIDISM)

45. RDA :
Adult male and female - 150 mcg/day
Higher during lactation and pregnancy
● Consuming diets high in goitrogens such as
cabbage, cassava and millet, limits the
bioavailability of Iodine.
● Deficiency result in cretinism.
● Upper Limit for adults is 1100 mcg per day.

46. 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
46

47. CHROMIUM
47
● Regulates plasma lipoprotein concentration and
reduces cholesterol and triglycerides.
● Cooking in stainless steel can increase chromium’s
content.
● Chromium exists in two main valency states:
trivalent and hexavalent.
● Chromium(VI) is better absorbed and more toxic
than chromium(III) and has also been listed as a
carcinogen implicated in lung cancer.
• Found in – grains, cereals, fruits, processed meat.

48. RDA : 20 – 35 mcg/ day
DEFICIENCY :
Uncommon; total parenteral nutrition, diabetes, or
malnutrition.
Chromium deficiency is characterized by glucose
intolerance, glycosuria, hypercholesterolemia,
decreased longevity, decreased sperm counts, and
impaired fertility
TOXICITY :
• Lung Carcinoma, Bronchogenic Carcinoma in
stainless steel workers, Dermatitis, skin ulcers 48

49. Reference Intervals for Chromium :
Chromium in whole blood: 0.7–28.0 g/L
Chromium in serum: 0.05–0.5 g/L
Chromium in urine: 0.1–2.0 g/24 hr
Chromium in RBCs: 20–36 g/L

50. MANGANESE
50
• Shown to be essential for normal growth and
development
• Role in human health is unclear
• Dietary sources: meat, fish, poultry, dry fruits and
nuts

51. BIOLOGICAL ROLE
Manganese superoxide dismutase, Arginase,
Glutamate synthase & Pyruvate carboxylase
• DEFICIENCY
Experimental animals - ↓growth, ↓fertility, ataxia,
skeletal deformities, abnormal fat and CHO
metabolism
51

52. • TOXICITY :
Neurotoxic- extrapyramidal parts affected
Headache
Hepatic dysfunction
• RDA – 2-11 mg/day
52

53. MOLYBDENUM
53
• Molybdenum (Mo) is a silvery white metal that is
very hard.
• Molybdenum in human tooth enamel may have a
role in lowering the risk of tooth decay.
• Act as a catalyst for enzymes and helps facilitate
breakdown of certain amino acids, corrosion
inhibitors, flame retardants, smoke repressants,
lubricants, and molybdenum blue pigments.
• RDA : 45mg/day
Pregnancy and Lactation - 50mg/day

54. DEFICIENCY :
Molybdenum cofactor deficiency is a recessively
inherited error of metabolism.
SYMPTOMS : include seizures, anterior lens dislocation,
decreased brain weight, and usually death prior to age 1
year.
TOXICITY :
High dietary and occupational exposures to
molybdenum have been linked to elevated uric acid in
blood and an increased incidence of gout.

55. REFERENCE INTERVALS FOR MOLYBDENUM
Molybdenum in whole blood: 60 g/L
Molybdenum in serum: 0.1–3.0 g/L
Molybdenum in red cells: 18 g/L
Molybdenum in urine: 8–34 g/L

56. SELENIUM
56
• 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.

57. DEFICIENCY :
Selenium deficiency has been associated with
cardiomyopathy, skeletal muscle weakness, and
osteoarthritis.
A significant negative correlation was observed
between selenium intakes and cancer of the large
intestine, rectum, prostate, breast, ovary, and lungs and
leukemia.
Keshan disease : An endemic cardiomyopathy that
affects mostly children and women in childbearing age in
certain areas in China, has been associated with selenium
deficiency

58. Functions in human body:
58
• 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

59. Selenium deficiency occurs due to :
● Hemolytic anemia
● Clansman's thrombasthenia (platelet disorder)
● Gastrointestinal cancer
● Malnutrition
59

60. BORON
60
• 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

61. Health benefits:
• Prevents arthritis
• Used for bodybuilding
• 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 61

62. XENON
62
• A trace element in earth’s atmosphere
• Xenon is a medical gas capable of establishing
neuroprotection, inducing anesthesia and
nuclear medicine as a contrast agent
• Acts through N-methyl-d-Aspartate receptor.