Abstract
Background: Niacin, a well-established agent for treating dyslipidemia, has been promoted
on the Internet as a method for passing urine drug screening, although there are no
data to support its use for this purpose. In a handful of cases, this practice has
resulted in serious niacin toxicity. Objectives: The aim of this article is to describe
a unique clinical presentation of niacin toxicity. Case Report: A 23-year-old previously
healthy man presented to an Emergency Department with altered mental status, fever,
acute renal failure, microangiopathic hemolytic anemia, thrombocytopenia, and coagulopathy.
It was revealed that he had taken approximately 22.5 g of sustained-release niacin
over the preceding 48 h in an attempt to pass a pre-employment urine drug screen.
After a complicated hospital course that included mechanical ventilation for respiratory
failure and hemodialysis for acute renal failure, the patient made a full recovery
and was discharged 10 days after his initial presentation. Conclusion: After a massive
niacin overdose, the young man in this case presented with a complex clinical picture
that mimicked concurrent thrombotic thrombocytopenic purpura and disseminated intravascular
coagulation. Although this patient was fortunate to make a full recovery, the case
highlights the potential for multi-system toxicity with niacin overdose, and the potential
for harm posed by medical misinformation on the Internet.
Keywords
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References
- Nicotinic acid: the broad-spectrum lipid drug.J Intern Med. 2005; 258: 94-114
- Toxicity from the use of niacin to beat urine drug screening.Ann Emerg Med. 2007; 50: 587-590
- Safety considerations with niacin therapy.Am J Cardiol. 2007; 99: 22C-31C
- Fulminant hepatic failure following low-dose sustained-release niacin therapy in hospital.West J Med. 1991; 155: 410-412
- Fulminant hepatic failure after ingestion of sustained-release nicotinic acid.Ann Intern Med. 1989; 111: 253-254
- Niacin-induced hepatitis: a potential side effect with low-dose time-release niacin.Mayo Clin Proc. 1991; 66: 23-28
- Niacin-induced myopathy.Am J Cardiol. 1994; 74: 841-842
- Case records of the Massachusetts General Hospital.N Engl J Med. 2001; 344: 591-599
- Toxicity and deaths from 3,4-methylenedioxymethamphetamine (“ecstasy”).Lancet. 1992; 340: 384-387
- Chronic ecstasy (3,4-methylenedioxymethamphetamine) abuse: a recurrent and unpredictable cause of severe acute hepatitis.J Hepatol. 1996; 25: 563-566
- Liver transplantation for the treatment of fulminant hepatic failure induced by the ingestion of ecstasy.Transpl Intern. 1997; 10: 229-233
- Ecstasy-induced toxicity in rat liver.Liver. 2000; 20: 8-15
- Nicotinic acid-induced toxicity associated with cytopenia and decreased levels of thyroxine-binding globulin.Mayo Clin Proc. 1992; 67: 465-468
- Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation.Thromb Haemost. 2001; 86: 1327-1330
- Randomized comparative study of the effects of treatment with once-daily, niacin extended-release/lovastatin and with simvastatin on lipid profile and fibrinolytic parameters in Taiwan.Kaohsiung J Med Sci. 2006; 22: 257-265
- Antioxidant and prooxidant activities of B group vitamins in lipid peroxidation.J UOEH. 2006; 28: 359-368
- Thrombotic thrombocytopenic purpura after Ecstasy-induced acute liver failure.Ann Intern Med. 1999; 130: 163
Article info
Publication history
Published online: February 08, 2010
Accepted:
November 15,
2009
Received:
October 4,
2009
Footnotes
No reprints are available from the author.
Identification
Copyright
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
