Carbohydrate loading in acute porphyria.

Date First Published:
July 17, 2006
Last Updated:
July 19, 2006
Report by:
Juliet Murray, 4th year medical student (MRI)
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.
Search Details:
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
Outcome:
Medline:207 results-0 relevant
Embase:145 results- 0 relevant
Cinahl: 8 results. 0 relevant
Cochrane: 32 results- 0 relevant
Relevant Paper(s):
Study Title Patient Group Study type (level of evidence) Outcomes Key results Study Weaknesses
Author Commentary:
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.
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