Patients with one of the hepatic porphyrias may develop an acute porphyric attack following a triggering event. The symptoms can be made worse by administering drugs that are porphyrinogenic. Attacks can be fatal.


Constitutional symptoms:

(1) fever

(2) sweating



(1) vomiting

(2) severe abdominal pain

(3) constipation

(4) ileus with abdominal distension



(1) hypertension

(2) tachycardia

(3) cardiac arrhythmias


Neurologic findings:

(1) pains in head, neck, chest and/or limbs without tenderness to palpation

(2) sensory loss

(3) muscle weakness

(4) psychiatric disorders including anxiety, depression, confusion, hallucinations, delusions, paranoia

(5) tremor

(6) peripheral neuropathy

(7) inappropriate secretion of ADH with hyponatremia


Severe attacks may result in:

(1) paralysis

(2) seizures

(3) respiratory arrest


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