At times, acute diffuse abdominal pain can be a diagnostic dilemma, especially when the symptoms appear to be out of proportion to the findings on physical examination. The case of a young boy with abdominal pain is presented

Afaq, A

Ahmed, M

Hasan, S

Jabbar, A

Jafri, W

Siddiqi, M

English

eCommons@AKU

eCommons@AKUSection of Gastroenterology Department of MedicineOctober 1995A young boy with abdominal painA JabbarAga Khan UniversityA AfaqAga Khan UniversityW JafriAga Khan University, wasim.jafri@aku.eduM SiddiqiAga Khan UniversityM AhmedAga Khan UniversitySee next page for additional authorsFollow this and additional works at: https://ecommons.aku.edu/pakistan_fhs_mc_med_gastroenterolPart of the Gastroenterology CommonsRecommended CitationJabbar, A., Afaq, A., Jafri, W., Siddiqi, M., Ahmed, M., Hasan, S. (1995). A young boy with abdominal pain. Journal of Pakistan MedicalAssociation, 45(10), 284-286.Available at: https://ecommons.aku.edu/pakistan_fhs_mc_med_gastroenterol/161AuthorsA Jabbar, A Afaq, W Jafri, M Siddiqi, M Ahmed, and S HasanThis report is available at eCommons@AKU: https://ecommons.aku.edu/pakistan_fhs_mc_med_gastroenterol/161Acute Intermittent Porphyria - A Diagnosis to ConsiderPages with reference to book, From 45 To 45 Shahab Abid, Syed Waseem Jafri, Zaigham Abbas, A. Haleem Khan, M. Ata Khan  ( Department of Medicine, Aga KhanUniversity, Karachi. ) Acute intermittent porphyria (AlP) is iatrogemc, a disease of medical progress and development.Serious clinical manifestations are often precipitated by ingestion of prescribed drugs. Like syphilis orhysteria, AlP may be termed as “little imitator1. We are presenting the clinical spectrum of AlP, with aview to highlight the possible misdiagnoses and important management issues.Patients, Methods and Results A computer search for AIP patients was made from the medical records of cases admitted betweenJanuaiy, 1991 and December, 1993. The charts of AlP patients were reviewed for presenting features,biochemical abnormalities and provisional diagnosis on first admission. There were 24 patients withamean age of 32.4 years (range 16-54 years). The clinical characteristics were abdominal pain andvomiting in 24 (100%), mental confusion in 19 (79%) and constipation in 18 (75%) patients. Otherpresenting features were backache, diarrhoea, chest pain and unconsciousness in less than 20% cases.Common clinical signs were tachycardia in 21(87.5%), fever in 17 (71%), dehydration in 17 (7 1%)and hypertension in 7 (29%) patients. Syndrome of inappropriate antidiuretic hormone (SIADH)secretion was present in 8 (33%) and depletional hyponatremia was present in 7(29%) patients. Therewere on an average 1.8 hospital admissions before the diagnosis of AlP could be made. Only six (25%)patients were diagnosed on their first admission as suffering from AlP. The other diagnoses on firstadmission were acute encephaliiis in eight (33.3%), intestinal obstruction due to antispasmodics inthree (12%), faecal impaction in five (21%) and hysterical motor weakness in two (8%) patients.Comments The manifestations of AlP in the present series are comparable to the large series2,3. The clinicalfeatures were mostly neurovisceral, highly variable and non-specific. This highlights the fact that AlPcan be easily misdiagnosed and a high degree of clinical suspicion is required to make an earlydiagnosis.Hyponatremia has come up as a special management problem in this review. It is recommended thatbefore presuming the SIADH as the cause of hyponatremia, every attempt should be made to excludeany fluid and electrolytes loss causing hyponatrernia so that the unnecessary water restrictionbeavoided. Another important point inthe management is the screening of the family members to detectthe career gene. These individuals are potentially at a high risk of developing an attack of AlP.We conclude that AlP should remain as one of the differential diagnosis in the clinical spectrum and itsmanageinent should be in the hands of expert professionals.References 1. Kappas, A., Sassa, S. and Anderson. K.E. The porphyrias. In: Stanbury, J.B., Wyngarrden, J.B.,Fredrickson, D.S et al, The metabolic basis of inherited diseases. 5th eds. New York, McGraw Hill,1983.2. Waldenstrom, J. The porphyrias as inborn errors of metabolism. Am. J. Med., 1957;22:758-773.3. Stein, J.A. and Tschudy, D.P. Acute intermittent porphyria - A clinical and biochemical study of 46patients. Medicine, 1970;49: 1-16.

A young boy with abdominal pain

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A young boy with abdominal pain

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