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Ammonia and carnitine concentrations in children treated with sodium valproate compared with other anticonvulsant
1Department of Child Health, University of Aberdeen, Medical School, Foresterhill.
Insights
Children on sodium valproate anticonvulsants showed lower carnitine levels and higher ammonia. This study investigated the impact of valproate on carnitine metabolism in pediatric patients.
Area of Science:
- Biochemistry
- Pediatric Neurology
- Pharmacology
Background:
- Anticonvulsant drugs are essential for managing epilepsy in children.
- Sodium valproate is a commonly prescribed anticonvulsant with a known side effect profile.
- Alterations in carnitine metabolism and ammonia levels can indicate underlying metabolic disturbances.
Purpose of the Study:
- To investigate the effect of sodium valproate on plasma ammonia and carnitine levels in children.
- To compare carnitine status in children on sodium valproate versus other anticonvulsants.
- To explore the relationship between carnitine, ammonia, and anticonvulsant therapy.
Main Methods:
- Plasma ammonia levels were measured in 59 children on anticonvulsants.
- Total and free carnitine were quantified in plasma and erythrocytes.
- Urinary carnitine was analyzed in a subset of patients.
- Children were divided into two groups: those on sodium valproate and those on other anticonvulsants.
Main Results:
- Children on sodium valproate exhibited higher plasma ammonia levels compared to controls.
- Significantly lower plasma and erythrocyte free carnitine were observed in children treated with sodium valproate.
- An increased ratio of acyl (bound) carnitine to free carnitine was noted in the sodium valproate group.
- Urinary free carnitine was reduced, and the bound to free carnitine ratio increased with valproate treatment.
- No significant correlation was found between plasma ammonia and carnitine concentrations.
Conclusions:
- Sodium valproate therapy in children is associated with altered carnitine metabolism, characterized by reduced free carnitine and increased acyl carnitine.
- Elevated plasma ammonia levels in children on sodium valproate may be linked to metabolic changes.
- Carnitine supplementation may be a potential therapeutic consideration for children on sodium valproate to mitigate metabolic disturbances.
Abstract:
Plasma ammonia was measured in 59 children requiring anticonvulsant drugs: 37 children (group 1) on sodium valproate alone or in combination with other drugs and 22 children (group 2) on drugs other than sodium valproate. Plasma ammonia was higher in group 1 children. Total and free carnitine was measured in plasma and erythrocytes of all children and in the urine of 16 children from group 1 and eight from group 2. Plasma and erythrocyte free carnitine was significantly lower in the children on sodium valproate, along with a significant increase in the ratio of acyl (bound) carnitine to free carnitine. No significant correlation was found between plasma ammonia and carnitine concentrations for either group of children. Plasma and erythrocyte concentrations were not related. Urinary free carnitine was reduced in children treated with valproate, with a significant increase in the ratio of bound to free carnitine. Carnitine supplementation is discussed.