• 
• 

Three Part Question

In [adults presenting to the emergancy department with an acute porphyric attack] does [carbohydrate loading as compared to conservative treatment alone] result in [more rapid resolution of symptoms]?

Clinical Scenario

A 53 year old female with acute intermittent porphyria presents to the emergancy department with abdominal pain. The medical student shadowing you who has done a special study module on acute porphyria tells you that carbohydrate loading had been the standard treatment for decades. You wonder if this could help resolve the attack.

Search Strategy

Medline 1966 to 06 /07, Embase 1980 to 06/07 and Cihanl 1982-06/06 via the Ovid interface.
Medline: [exp porphyrias or porphyria.mp. or porphyrias.mp. or AIP.mp.]AND [exp Dietary Carbohydrates/ or exp Carbohydrates/ or carbohydrate$.mp. or exp glucose or glucose.mp. or carbohydrate adj loading] LIMIT humans and english
Embase and Cinahl:[exp porphyria or porphyria.mp. or porphyrias.mp. or AIP.mp.]AND [exp Dietary Carbohydrates/ or exp Carbohydrates/ or carbohydrate$.mp. or exp glucose or glucose.mp. or carbohydrate adj loading] LIMIT humans and english
Cochrane Library-porphyria

Search Outcome

Medline:207 results-0 relevant
Embase:145 results- 0 relevant
Cinahl: 8 results. 0 relevant
Cochrane: 32 results- 0 relevant

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses

Comment(s)

Carbohydrate loading has ben the standard treatment for acute porphyric attacks for decades[1]. However there is no evidence to suggest it is effective. Research is needed.

Clinical Bottom Line

There is no evidence to suggest carbohydrate loading is of use in the acute porphyric attack.

References

1. Anderson KE, Bloomer JR, Bonkovsky et al Recomendations for the diagnosis and treatment of the acute porphyrias Annals of internal medicine 2005;142:439-450