Abstract
We studied urine calcium and magnesium excretions during treatment with adrenocorticotropic hormone (ACTH-T) and ketogenic diet (KD-T) in 5 intractable epileptic children. The daily urine calcium excretion was evaluated by the urinary calcium/creatinine ratio (U-Ca/Cr) of 24-hour urine or urine specimens passed early in the morning.
In all cases U-Ca/Cr rose and the urinary magnesium/calcium ratio (U-Mg/Ca) decreased during both ACTH-T and KD-T. These changes were normalized gradually after the end of treatment.
Serum calcium and phosphate showed no significant changes during both treatments, while serum alkaline phosphatase were reduced during ACTH-T and increased during KD-T. But urinary excretion of oxalate measured in two patients during ACTH-T and in a patient during KD-T revealed no definite changes.
Hydrochlorothiazide was not effective for prevention of hypercalciuria in a patient who had experienced urolithiasis during the previous ACTH-T. Sodium bicarbonate prevented the elevation of U-Ca/Cr during KD-T, but aggravated epileptic seizures. U-Mg/Ca was improved by magnesium oxide during KD-T.
It is well known that both glucocorticoids and metabolic acidosis cause hypercalciuria by increasing tubular reabsorption of calcium. It is also thought that increase of U-Ca/Cr and decrease of U-Mg/Ca predispose patients to suffer from urinary stones of calcium oxalate. Our study suggests that both ACTH-T and KD-T could induce hypercalciuria and reduce U-Mg/Ca. It is important to give careful consideration to urine calcium and magnesium excretions during treatment of intractable epilepsy in children.
