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Anticonvulsive drugs and blood levels of lactate, pyruvate, and glucose in children with seizures

Lactate, pyruvate, and glucose were determined in groups of 10 patients, each receiving single drug therapy for their seizure disorder with either phenytoin, valproic acid, carbamazepine, or phenobarbital, and in patients not taking medication. All drug levels were in their therapeutic ranges. The characteristics of the groups were similar, except for the phenytoin group being significantly older. No significant differences were found in glucose or pyruvate concentrations. However, patients on valproic acid had reduced lactate (p < 0.05) and L/P ratios (p < 0.05). The reduction in lactate in patients on valproate therapy may mask inborn errors of metabolism that normally result in an increase in blood lactate levels.