E0029467

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Not Applicable (or Unknown)

コウ テンカンヤク バルプロサン ノ チョウキ フクヨウジ ニオケル コウ アンモニア ケッショウ ニカンスル ケンキュウ

A study on valproate-induced hyperammonemia

Japanese (日本語)

Medical journal of Kobe University

47(3)

33-39

1986-09

Hyperammonemia is a side effect of VPA therapy. The mechanism of vaiproate-induced hyperammonemia is poorly understand. The purpose of this study is to determine those factors of valproateinducedhyperammonemia. Patients and Methods ; Serum ammonia, serum amino acids, and serum free carnitine concentrations were measured in 92 epileptic outpatients and 62 epileptic inpatients with severe handicaps. There was no patient with clinical hepatic dysfunction in this study. Outpatients were divided into 5 groups ; control (groupA), VPA monotherapy (groupB), poly therapy with VPA (groupC), PB or CBZ monotherapy (groupD), and polytherapry without VPA (groupE). Inpatients with severe handicaps were divided into 3 groups ; control (groupA') , poly therapy with VPA (groupC') and poly therapy without VPA (groupE'). Results; Serum ammonia levels of groupC (n=25,61.7±24.1μg/dl) were significantly higher than those of groupA (n=12,39.3±12.5), groupB (n=8,39.9±13.6), and groupD (n=13,39.3±9.9). Serum ammonia levels of groupC' (n=31,121.9±48.6) were significantly higher than those of groupA' (n=16,48.6±13.2), groupE'(n=15,68.9±20.0), and groupC. Serum anmmonia levels of 6 patients in groupC'tend to increase after meal. Patients whose seum ammonia levels were above 80μg/dl in groupC' indicated markedly lower body weight compared to that of age-matched children, and serum albumin levels of them (n=24,3.8 ± 0.42 g/dl) were lower than those of patients whose serum ammonia levels were below 80μg/dl in groupC (n=20,4.18±0.34). Serum free carnitine levels of groupC (n=25,42.5±9.8nm/ml)were lower than those of groupA (n=7,57.3±7.7), groupB (n=11,55.7±8.6), groupD (n=26,48.5±11.2), and groupE(n=12,53.2±7.9). Serum free carnitine levels of groupC' (n=25,36.6±11.5) were lower than those of groupA' (n=7,51.3±13.5) and groupE' (n=5,52.8±17.4). After oral administration of DL-carnitine (50mg/kg/day) for 5 weeks, serum free carnitine levels reached to normal range, while hyperammonemia was not improved. Conclusions ; These results suggest that those factors of the VPA-induceed hyperammonemia are poly therapy with VPA, severly handicapped children, malnutrition, protein load, and low levels of serum free carnitine.

polypharmacy

紀要論文