Q: 28 years old male has repeated history of ED presentation with acute abdomen requiring narcotics analgesics. Record shows complete negative workup on each visit to ED. While evaluating this time your medical student suggested acute intermittent porphyria. Which test you should order?


Answer: Urine Porphobilinogen

Urine Porphobilinogen is a porphyrin precursor. This may not be included in hospital's standard urine porphyrin screen test and must be ordered specially. Acute intermittent porphyria patients have elevated porphobilinogen even between attacks though in some patients with long gaps between attacks, porphobilinogen may return to the normal range.