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Key Features

  • Most commonly results from alcoholism and nutrient–drug interactions

  • Can also occur in inborn errors of metabolism

  • Manifestations are nonspecific

Clinical Findings

  • Common complaints

    • Anorexia

    • Weakness

    • Irritability

    • Mouth soreness

    • Glossitis

    • Stomatitis

    • Weight loss

  • More advanced deficiency results in the classic triad of pellagra: dermatitis, diarrhea, dementia

  • Advanced pellagra can result in death

Diagnosis

  • Diagnosis of pellagra is made clinically

  • Measure niacin metabolites, particularly N-methylnicotinamide, in the urine

  • Serum and red blood cell nicotinamide adenine dinucleotide and nicotinamide adenine dinucleotide phosphate levels are low

Treatment

  • Niacin, usually given as nicotinamide, 10–150 mg orally once daily

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