Acute intermittent porphyria is an unusual pathology with potentially severe consequences when not early detected. Among the possible causes of porphyric crises decrease of caloric intake has been described. A case of
acute intermittent porphyria in the late postoperative period of a
bariatric surgery performed for treatment of
obesity is reported. A review of the diagnostic aspects and management of this pathology in the intensive care unit follows. A 31 year old woman was admitted in the intensive care unit three weeks after a
bariatric surgery, with decreased level of consciousness and respiratory distress. The patient evolved with
psychomotor agitation, mental
confusion,
abdominal pain and proximal tetraparesis. Diagnosis investigation disclosed severe
hyponatremia (92mEq/L), hypomagnesemia, hypophosfatemia and
hypocalcemia and cloudy urine without
hematuria.
Acute porphyria was suspected and the urine test detected high delta amino-
levulinic acid and
porphobilinogen. Treatment consisted of a correction of
electrolyte disturbances and high
carbohydrate intake.
Hematin and
heme arginate were not used, due to the difficulty to acquire the medication. After 8 months the patient progressed with full recovery of muscle strength and a clinical improvement.
Acute intermittent porphyria has signs and symptoms common to several clinical, neurological, psychiatric and gastroenterological pathologies, which complicate diagnosis. Therefore,
acute intermittent porphyria should be included in the differential diagnosis of neurological, psychiatric and gastroenterological alterations when results of all other exams are normal. Attention must be given to patients undergoing surgery mainly bariatric that, in addition to procedure stress, substantially limit the total caloric intake, potentially triggering crises. Review of literature did not disclose any report of
acute intermittent porphyria crisis induced by
bariatric surgery.