We describe a case of acute intermittent porphyria in a woman who presented repeatedly with abdominal pain. Porphyrias are caused by decreased enzyme activity in the heme biosynthetic pathway leading to overproduction of heme precursors if demand increases. This can cause symptoms such as abdominal pain, nausea and vomiting, constipation, tachycardia and hypertension. Treatment includes removal of causative factors, administration of carbohydrates or hemin to reduce the production of heme precursors as well as symptomatic treatment.

Figure I.

Table I.

	On admission	3rd day	5th day
White blood cells (x109/l) [4,0-10,5]	6,5	-	-
Hemoglobine (g/L) [118-152]	166*	173*	145
Blood platelets (x109/L) [150-400]	137*	-	-
Sodium (mmol/L) [137-145]	133*	119*	134*
Osmolalitet (mosm/kg) [280-300]	-	246*	-
Potassium (mmol/L) [3,5-5,0]	3,7	3,5	3,5
Creatinine (µmol/L) [50-90]	74	59	69
Lipase (U/L) [25-300]	271	1282*	186
Amylase (U/L) [25-120]	-	209*	61
ASAT (U/L) [<35]	74*	60*	-
ALAT (U/L) [<45]	112*	97*	-
CRP (mg/L) [<3]	<3	-	-
* Abnormal results
Units given in parenthesis and normal values in brackets

Table II.

		Frequency of occurrence
Autonomic neuropathy
	Abdominal pain	85-95%
	Nausea, vomiting	43-88%
	Constipation	48-84%
	Tachycardia	64-85%
	Systemic hypertension	36-55%
Peripheral neuropathy
	Pain in extremities, back, chest, neck, head	50-70%
	Paresis, most often in proximal muscles	42-68%
	Respiratory paralysis	9-20%
	Sensory loss
	Urinary retention
Central nervous system involvement
	Agitation, insomnia, confusion, hallucinations, depression, anxiety	40-58%
	Convulsions	10-20%
Hyponatremia