Mohammad Ishaq Khattak, Faiz Ur Rehman.
Acute Intermittent Porphyria presenting as acute abdomen.
J Postgrad Med Inst Jan ;17(1):140-2.

A 20 year old unmarried lady was referred with a 3 days history of sore throat, followed by acute abdominal pain and vomiting for which she was operated by a local surgeon with a diagnosis of acute appendicitis, under ketamine anaesthesia. Her recovery was not satisfactory but she was sent home on 3rd postoperative day, while on the way to home, she became drowsy, confused and restless, and also having abdominal pain with vomiting. She was brought back to AHQ Hospital Miranshah from where she was shifted to KTH Peshawar. She was first admitted in Medical `D` Unit and than shifted to Medical ICU. On examination she was apyrexial but confused and drowsy, having tachycardia and blood pressure of 170/105 mmHg. Her sensory and motor systems were intact, other systemic examinations were unremarkable except dehydration, generalized tenderness of the abdomen and appendicectomy scar. Her base line investigations were done, which showed leucocytosis, albuminuria, and raised blood urea. CSF examination was normal. Serum potassium and sodium were low. Abdominal U/ and C.T. Brain were normal LFTs were slightly impaired while HBSAg and HCV antibodies titre were negative. Urinary uroporphyrin and corpoporphyrin were positive. Analgesia, parintral fluids specially D/water were given, while hematin, the most specific therapy, was not available in the market. The patient recovered completely and was discharged after 10 days of hospitalization.

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