Rapid responses are electronic letters to the editor. They enable our users to debate issues raised in articles published on thebmj.com. Although a selection of rapid responses will be included online and in print as readers' letters, their first appearance online means that they are published articles. If you need the url (web address) of an individual response, perhaps for citation purposes, simply click on the response headline and copy the url from the browser window. Letters are indexed in PubMed.
This case report is quite chilling for anaesthetists as careful, cautious and well considered care might have resulted in major unintended harm for the patient. The acute presentation could easily have been misinterpreted as a surgical emergency and resulted in an operative intervention under general anaesthesia. Without porphyria being suspected as the diagnosis, the use of a standard rapid sequence intravenous induction with the barbiturate thiopentone would have been both very reasonable - and very hazardous.
We too should avoid missing a rare condition by colouring our judgement purple.
No competing interests
26 April 2017
Emma L Simpson
Mark W Davies, Consultant
Royal Liverpool & Broadgreen University Hospitals NHS Trust