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The administration of pteroylmonoglutamic acid and either sodium bicarbonate or phenytoin sodium in normal subjects and epileptics results in lower serum levels of folic acid than when administered alone. Bicarbonate administration was shown to produce a more alkaline pH in the jejunum, while an alkaline pH was found in some epileptics on phenytoin therapy. The physicochemical mechanisms whereby folic acid absorption is reduced in an alkaline medium are considered, and the implications on folate absorption in other disease states are discussed. The mechanism by which phenytoin sodium alters the intrajejunal milieu is obscure.
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