understanding a patient with porphyria

[YSADL]

At the hospital I work at has a patient that comes in frequently with acute intermittent porphyria. (hope I'm spelling it correctly) All I see me doing for this patient is giving IVP of D50 every hour PRN and 8mg morphine which also is PRN. I think of myself as a hands on type person. With this diagnosis, I have quite hard time understanding how to assess this patient. Recently, this patient, came in as an outpatient, recieved three hours of D5w at 100cc per hour and three amps of D50 and felt son much better. The hospital is quite small (rural) and dosen't have all the diagnostic equipment that bigger ones have. The patient claims that the diagnosis was made a larger facility yet refuses to be transferred there. On one occasion, we tried to get records from that hospital but the patient refused to sign release form. Patient made comment that the doctor has a copy and the hospital does not need it. The part that frustrates me the most is I just don't understand the disease process or the patient is lying with the doctor feeding in to it. Please can some one help me better so I can care for this challenge. Thanks!

[Nurse Ratched, RN]

Is the presentation derm or GI? We recently had a pt who was addicted to certain meds and supposedly had porphyria (my first interaction with this illness.) Turns out his testing was negative. We also could not secure his records so drew labs to send out to a place that could run them, which is when the pt was un-diagnosed.

Bottom line, if the attending provider can neither document nor care for the illness, he needs to go where they can. This takes your facility out of the middle and gets the pt where care can be given, or his ruse can be uncovered, whichever is appropriate .

I would be VERY surprised if whoever the attending doc is doesn't have some clinical data verifying the illness. If he doesn't, he needs to.

[mango-lo-maniac]

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