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VOLUME 14 , ISSUE 2 ( April, 2010 ) > List of Articles


Intensive care management of patients with acute intermittent porphyria: Clinical report of four cases and review of literature

Madhur Mehta, Girija Rath, Uma Padhy, Manish Marda, Hari Dash

Keywords : Acute intermittent porphyria, intensive care management, respiratory failure

Citation Information : Mehta M, Rath G, Padhy U, Marda M, Dash H. Intensive care management of patients with acute intermittent porphyria: Clinical report of four cases and review of literature. Indian J Crit Care Med 2010; 14 (2):88-91.

DOI: 10.4103/0972-5229.68222

License: CC BY-ND 3.0

Published Online: 01-04-2010

Copyright Statement:  Copyright © 2010; Jaypee Brothers Medical Publishers (P) Ltd.


Acute intermittent porphyria (AIP), the most common and the most severe form of acute hepatic porphyria, is an autosomal dominant condition. It results from lower-than-normal levels (less than 50%) of porphobilinogen (PBG) deaminase. Patients may present commonly with gastrointestinal complaints and neuropsychiatric manifestations. Diagnosis may be confirmed with the presence of intermediary metabolites of haem synthesis, amino levulinic acid (ALA) and PBG in urine or with specific enzyme assays. Abdominal pain is the most common symptom (90%). Peripheral polyneuropathy, primarily motor with flaccid paresis of proximal musculature, with or without autonomic involvement, is characteristic. Respiratory failure necessitates ventilator and intensive care support. Avoidance of precipitating factors and the use of haem preparations and intravenous dextrose form the basis of management. Gabapentin and propofol, rather than the conventional antiepileptics appear to be the appropriate choice for seizure control. Here, we present intensive care management of four cases of AIP with varying clinical presentation.

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  1. Desnick RJ. The Porphyrias. In: Braunwald E, Fauci AS, Kasper DL, et al. (Eds.) Harrison′s Principles of Internal Medicine,15 th edn. New York: McGraw Hill Companies Inc; 2001. p. 2261-7.
  2. Oomman A, Gurtoo A. Acute intermittent porphyria as a cause of respiratory failure. J Indian Med Assoc 2002;100:44-6.
  3. Suarez JI, Cohen ML, Larkin J, Kernich CA, Hricik DE, Daroff RB. Acute intermittent porphyria: clinicopathologic correlation. Report of a case and review of the literature. Neurology 1997;48:1668-83.
  4. Laiwah AC, Macphee GJ, Boyle P, Moore MR, Goldberg A. Autonomic neuropathy in acute intermittent porphyria. J Neurol Neurosurg Psychiatry 1985;48:1025-30.
  5. Meyer UA, Schuurmans MM, Lindberg RL. Acute porphyrias: pathogenesis of neurological manifestations. Semin Liver Dis 1998;18:43-52.
  6. Periasamy V, al Shubaili A, Girsh Y. Diagnostic dilemmas in acute intermittent porphyria. A case report. Med Princ Pract 2002;11:108-11.
  7. Harrison JC, McAuley FT. Propofol for sedation in intensive care in a patient with an acute porphyric attack. Anaesthesia 1992;47:355-6.
  8. Pandey CK, Singh N, Bose N, Sahay S. Gabapentin and propofol for treatment of status epilepticus in acute intermittent porphyria. J Postgrad Med 2003;49:285-5.
  9. Zadra M, Grandi R, Erli LC, Mirabile D, Brambilla A. Treatment of seizures in acute intermittent porphyria: safety and efficacy of gabapentin. Seizure 1998;7:415-6.
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