Acute intermittent porphyria precipitated by hyperemesis and metoclopramide treatment in pregnancy

Acute intermittent porphyria is an inherited deficiency of porphobilinogen deaminase manifested by autonomic disturbances including abdominal pain, ileus and constipation, as well as neuropsychiatric manifestations, such as peripheral neuropathy, hallucinations, confusional states, seizures, and cerebral and hypothalamic abnormalities. In susceptible patients these attacks are precipitated by endogenous factors, including menstrual cycle and pregnancy, or by exogenous factors such as drugs, hormones (especially estrogens), emotional stress or starvation states. Although it is recognized that hyperestrogenic status during pregnancy may precipitate attacks of acute intermittent porphyria, only a few cases that initially presented during pregnancy have been reported.