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Serum alkaline phosphatase and urinary hydroxyproline values in children receiving phenobarbital with and without

D Liakakos, Z Papadopoulos, P Vlachos

    The Journal of Pediatrics
    |August 1, 1975
    PubMed

    Insights

    Phenobarbital use in children receiving anticonvulsants may increase rickets risk by altering bone metabolism markers. Daily vitamin D supplementation appears crucial for preventing or reversing these biochemical changes.

    Area of Science:

    • Pediatric Endocrinology
    • Clinical Pharmacology
    • Biochemistry

    Background:

    • Anticonvulsive medications are frequently prescribed for prolonged periods in children.
    • Concerns exist regarding the potential skeletal side effects of long-term anticonvulsant therapy, specifically rickets.
    • Phenobarbital is a commonly used anticonvulsant with a known impact on vitamin D metabolism.

    Purpose of the Study:

    • To investigate the effect of phenobarbital on biochemical markers associated with rickets development in children on long-term anticonvulsant therapy.
    • To assess the efficacy of vitamin D supplementation in mitigating phenobarbital-induced biochemical derangements.

    Main Methods:

    • Serum alkaline phosphatase (AP) and total urinary hydroxyproline (HOP) levels were measured in 36 children.
    • Children were receiving anticonvulsive medications, with a focus on phenobarbital administration.
    • Intervention included a single large dose of vitamin D and a two-month daily regimen of 4,000 IU vitamin D.

    Main Results:

    • Phenobarbital administration rapidly increased AP and HOP values, indicating early biochemical changes suggestive of rickets, even without overt bone abnormalities.
    • A single large oral dose of vitamin D did not correct these biochemical alterations.
    • Daily vitamin D (4,000 IU for two months) effectively prevented or reversed latent rickets changes in children on anticonvulsants.

    Conclusions:

    • Phenobarbital administration is strongly implicated in the development of rickets in children undergoing long-term anticonvulsant treatment.
    • Daily vitamin D supplementation is essential for children receiving anticonvulsive drugs to prevent or manage rickets.
    • Monitoring bone metabolism and ensuring adequate vitamin D intake are critical in this patient population.

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