Porphyrias Flashcards
three porphyria disorders
- acute intermittent porphyria
- Porphyria Cutanea Tarda
- Lead Poisoning
acute intermittent porphyria has defect in which enzyme and requires the induction of which enzyme
PBG deaminase; ALAS
porphyrias
are disorders with deficiencies with enzymes that help make heme; cause buildup of porphyrins (metabolites); usually inherited
PBG deaminase completes which reaction
occurs in the cytoplasm
PBG (porphobilinogen) –> HMB (hydroxymethylbilane)
porphyria can lead to
facial hair and red glowing teeth
What is the committed enzyme for formation fo heme?
ALAS
What induces ALAS activity?
- hepatic depletion of heme
- metabolic stress
- drugs
- hormones
- smoke
clinical presentation of AIP ?
- increased catecholamines which can increase heart rate and lead to hypertension
- CNS- seizures
- GI pain without inflammation
- insomnia
- acute and intermittent
- SIADH- hyponatremia (low sodium)
- red or dark urine when exposed to sunlight
ALAS reaction
succinyl CoA + glycine –> ALA
acute intermittent porphyria has what type of inheritance
autosomal dominant
acute intermittent porphyria is low or high penetrance
low
laboratory findings
- increased ALA and PBG
2. decreased activity of PBG deaminase
treatment
- stop induction so medication, smoking, drug, metabolic stress
- increase carbohydrates
- glucose 10 %
- hematin
hematin inhibits which enzyme
ALAS
prolonged attacks of AIP can lead to which peripheral neuropathy motor symptoms
- bulbar paralysis
- respiratory impairment
- death
exacerbating factors of AIP?
- decreased carb diet
- drugs
- hormones
- metabolic stresses- infections, surgery, psychological stress
- cigarette smoke
Porphyria Cutanea Tarda is caused by
deficiency of UROD (uroporphyrinogen decarboxylase)
UROD uroporphyrinogen decarboxylase reaction
uroporphyrinogen III –> coprophyrinogen III
what leads to reduced activity of the enzyme
iron overload
______ is correlated with clinical expression of this disease
hepatic iron levels
three associated disorders
- alcoholism
- hemochromatosis
- hep C
when uroporphyrinogen is made in the _____ it is deposited in the _______ as a metabolite and causes ____
liver; skin; blisters and rash
patients with PCT are at increased risk for
cirrhosis and heptacellular carcinoma
diagnosis
clinical
- normal levels of ALA and PBG
PCT treatment
- remove all offending agents (alcohol, smoke and estrogen)
- sunscreen and sun exposure protection
- phlebotomy
lead poisoning is microcytic or macrocytic
microcytic
lead poisoning in children is usually via ______ and in adults via ______
ingestion; inhalation
forms of lead
- moonshine
- makeup
- gas
- paint
- water
clinical signs of lead poisoning
- lead line
- decreased libido
- muscle joint pain
- wrist and foot drop
- microcytic anemia
- GO effects- crampy abdominal pain (lead colic) constipation
diagnosis
- blood test
- venous for children
treatment
- reduce lead exposure
- chelation therapy
lead poisoning level for children ___
lead poising for adults
5
10
should be 0
once in the body 99% of lead is bound to
RBS
lead biochemical effects
inhibits ALAS and ferrochelatase
ferrochelatase
last enzyme that formation of heme adds the Fe
blood smear for lead poisoning shows
basophilic stippling
lead exposure chronic effects
- hypertension
- neuropsychiatric effects
- mortality
- reproductive effects
- lead neuropathy
- saturnine gout
chelation therapy
should not be used unless exposure has been definitively curtailed since in the presence of continuous exposure it can cause increased absorption
atkins diet
low carb diet that can induce ALAS