Sodium valproate-induced Fanconi syndrome in two severely disabled patients receiving carnitine supplementation
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To the Editor,
Carnitine (Car) deficiency is a common side effect caused by sodium valproate (VPA) administration . Because VPA is a medium-chain fatty acid isomer, it consumes Car as valproil-Car during its metabolism . Since Car has an important role in mitochondrial energy production, its deficiency causes various dysfunctions in many organs . Fanconi syndrome (FS) is characterized by renal proximal tubular dysfunction, resulting in amino aciduria, glycosuria, proteinuria, metabolic acidosis, hypophosphatemia, and hypokalemia . Several agents including anticancer drugs, heavy metals, and anticonvulsants such as VPA can cause acquired FS . Although the basis for development of FS due to VPA remains unknown, Koga et al. proposed that reduced production of ATP induced by secondary Car deficiency might be associated . However, it is also suspected that Car deficiency might be the result rather than the cause, because there have been no reports of serum Car levels...
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