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[Phosphorus-calcium metabolism in children under long-term anticonvulsant therapy]
M D Lluch Fernández1, M J Peña Griñán, R Pérez Cano
1Hospital Universitario Virgen Macarena, Sevilla.
Insights
Prolonged anticonvulsant use in children significantly lowers phosphorous and 25-hydroxycholecalciferol levels while increasing alkaline phosphatase. These biochemical changes in phosphocalcium metabolism warrant further investigation for long-term health implications.
Area of Science:
- Pediatric Endocrinology
- Biochemistry
- Pharmacology
Background:
- Anticonvulsant medications are frequently prescribed for children with epilepsy.
- The long-term effects of these drugs on mineral metabolism are not fully understood.
- Phosphocalcium metabolism is crucial for bone health and overall development in children.
Purpose of the Study:
- To investigate the impact of prolonged anticonvulsant administration on biochemical markers of phosphocalcium metabolism in children.
- To compare these markers in children receiving anticonvulsants with a control group of healthy children.
- To assess the influence of age and solar radiation on these metabolic parameters.
Main Methods:
- Biochemical analysis of serum calcium, phosphorous, alkaline phosphatase, 25-hydroxycholecalciferol, osteocalcin, and parathyroid hormone.
- Utilized autoanalysis, radioimmunoassay, and colorimetric measurements for precise determinations.
- Compared data from 98 children on anticonvulsants with a control group, considering age and seasonal variations in solar exposure.
Main Results:
- Children on anticonvulsants showed significantly lower phosphorous (p=0.000) and 25-hydroxycholecalciferol (p=0.000) levels.
- Elevated alkaline phosphatase levels (p=0.000) were observed in the treated group.
- No significant differences were found in calcium, parathyroid hormone, or osteocalcin levels between groups.
Conclusions:
- Prolonged anticonvulsant therapy in children disrupts phosphocalcium metabolism, specifically affecting phosphorous and vitamin D levels.
- The observed increase in alkaline phosphatase suggests potential effects on bone turnover.
- Further research is needed to elucidate the clinical significance and long-term consequences of these biochemical alterations.
Abstract:
The effects of prolonged administration of anticonvulsants were analyzed on different biochemical parameters related to phosphocalcium metabolism in 98 children aged 1 to 14, not affected by other chronic pathology, and to whom no Vitamin D nor other vitamin-mineral complexes had been administered. We take as reference a group of normal children studied during the same period. Determinations were accomplished with the usual chemical controls in our laboratory (autoanalysis of continuous flow, radioimmunoassay and colorimetric measurements) and the following mean levels were obtained for treated children: Calcium: 9.2 +/- 0.4 mg/dl, phosphorous: 3.5 +/- 1.9 mg/dl, alkaline phosphatase: 252 +/- 72 U/L, 25-Hydroxycholecalciferol: 35.6 +/- 18 ng/ml, Osteocalcine: 5.4 +/- 3.6 ng/ml, and parathyroid hormone: 0.4 +/- 0.1 ng/ml. These values differed significantly from those found in the control group for phosphorous, lower in children under treatment (p = 0.000), and the 25-Hydroxycholecalciferol was likewise lower (p = 0.000). In other way the mean levels of alkaline phosphatase were higher in treated children (p = 0.000). No significant differences were obtained for mean levels of calcium, parathyroid hormone and osteocalcine. These differences are maintained when distributing patients among different age groups. Solar radiation received by treated children during the months preceding the extraction, did not produce significant differences on 25-Hydroxycholecalciferol, with mean values that were similar at the end of summer (34 +/- 9 ng/ml) and the end of winter (36.6 +/- 18 ng/ml).