Clinical Features of an acute porphyria attack 

Signs

  • fast heart rate (tachycardia)

  • high blood pressure (hypertension) 

  • blood pressure that drops when standing up from a lying or sitting position (orthostatic hypotension) 

  • heart rate and blood pressure that increase suddenly then decrease to normal

  • seizures

  • paralysis

  • coma

Symptoms

  • Pain can be in the abdomen,  or,  head, neck, back, legs, and chest. 93% of AIP attacks may have ab pain.

  • abdominal pain that is described as a burning sensation.

  • bone pain

Laboratory Findings 

  • decreased sodium (hyponatremia), decreased potassium (hypokalemia), decreased magnesium (hypomagnesemia)

  • decreased cortisol

  • elevated white blood cells (leukocytosis)

  • elevated antinuclear antibodies

  • elevated catecholamines

  • elevated creatine kinase (rhabdomyolysis)

  • Secretion of inappropriate Anti Diruretic hormone

  • the patient may have increased pbg and ala not all patients do

  • or may have a positive plasma fluorescence test 70% of HCP wont be positive test.

  • or may have elevated fecal porphyrins 30% may not