ANTICONVULSANT INDUCED METABOLIC DISORDER - CASE REPORT

Broj: 1, 2008 Rubrika: Prikaz bolesnika Autori: Dušanka Martinović Kaliterna, Zrinka Jurišić

Osteomalacija je metabolička bolest odraslih kod koje je poremećena mineralizacija organskog matriksa kosti. Vezana je uz različite poremećaje metabolizma vitamina D, a može se javiti i kod primjene antikonvulzivnih lijekova. Antikonvulzivi ubrzavaju katabolizam vitamina D induciranjem mikrosomskih enzima jetre, smanjuju bubrežnu hidroksilaciju vitamina D, imaju direktan učinak na gastrointestinalnu apsorpciju kalcija i s tim na remodelaciju kosti neovisnu o metabolizm  vitamina D. U radu je prikazana bolesnica u koje je dugotrajna politerapija antikonvulzivima prouzročila osteomalaciju i nepokretnost. Ova nuspojava poznata je u kliničkoj praksi više od trideset godine, ali nema jasnih smjernica za praćenje osteomalacije kao i za primjenu vitamina D i kalcija u bolesnika liječenih antikonvulzivnom terapijom.

Osteomalacia, metabolic bone disease in the adults, is disorder in which mineralization of the organic matrix of the skeleton is defective. This disorder is caused by a number of different conditions associated with alterations of vitamin D metabolism. Anticonvulsant therapy can also cause the development of osteomalacia due to alteration of vitamin D metabolism inducing hepatic mycrosomal enzymes, inhibiting 25-hydroxilation of vitamin D. They also inhibit intestinal calcium transport and bone mineral mobilization, independent of effects on vitamin D metabolism. This paper presents a patient who was unable to walk due to anticonvulsants induced osteomalacia. Anticonvulsant use has been implicated as a cause of bone disease for more than 30 years but there is no official recommendation for calcium and vitamin D therapy in anticonvulsant treated individuals.

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