Clinical Chemistry

Case 124

706 Comments
1. Presented by Yembur Ahmad, MD and reviewed by Claire Knezevic, PhD

An adult patient presented to the emergency department with diffuse abdominal pain, and 2 days of emesis and diarrhea. Their history was significant for several prior similar presentations, attributed to cannabinoid hyperemesis syndrome due to daily marijuana use, with bouts of emesis occurring at regular intervals (every 1-2 months). On examination, their abdomen was diffusely tender to palpation. The patient was diagnosed with another episode of cannabinoid hyperemesis syndrome, managed with supportive therapy, and discharged home.
A few months later, the patient presented again with severe abdominal pain. However, this time the patient developed hypertensive emergency and posterior reversible encephalopathy syndrome (PRES), requiring admission to the ICU. During this admission, a random urine porphobilinogen was found to be elevated. A presumptive diagnosis of acute porphyria was made, pending further workup with specific enzyme testing, but thought to be most consistent with acute intermittent porphyria (AIP).

Question: Which of the following enzymes is affected in patients with acute intermittent porphyria (AIP)?

 

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    B52 Club tự hào với đội ngũ hỗ trợ khách hàng chuyên nghiệp, tận tâm và hiệu quả. Người chơi có thể liên hệ thông qua các kênh như chat trực tuyến, email, điện thoại, hoặc mạng xã hội. Vấn đề kỹ thuật, tài khoản hay bất kỳ thắc mắc nào đều được giải quyết nhanh chóng.

    4. Phương Thức Thanh Toán An Toàn
    B52 Club cung cấp nhiều phương thức thanh toán để đảm bảo người chơi có thể dễ dàng nạp và rút tiền một cách an toàn và thuận tiện. Quy trình thanh toán được thiết kế để mang lại trải nghiệm đơn giản và hiệu quả cho người chơi.

    5. Chính Sách Thưởng và Ưu Đãi Hấp Dẫn
    Khi đánh giá một cổng game B52, chính sách thưởng và ưu đãi luôn được chú ý. B52 Club không chỉ mang đến những chính sách thưởng hấp dẫn mà còn cam kết đối xử công bằng và minh bạch đối với người chơi. Điều này giúp thu hút và giữ chân người chơi trên thương trường game đánh bài trực tuyến.

    Hướng Dẫn Tải và Cài Đặt
    Để tham gia vào B52 Club, người chơi có thể tải file APK cho hệ điều hành Android hoặc iOS theo hướng dẫn chi tiết trên trang web. Quy trình đơn giản và thuận tiện giúp người chơi nhanh chóng trải nghiệm trò chơi.

    Với những ưu điểm vượt trội như vậy, B52 Club không chỉ là nơi giải trí tuyệt vời mà còn là điểm đến lý tưởng cho những người yêu thích thách thức và may mắn.

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