Niacin Deficiency (Pellagra)
A distinctive dark red rash may appear on the hands, feet, calves, neck, and face. The tongue and oral mucosa can also become dark red.
Niacin deficiency frequently coexists with deficiencies in protein, riboflavin (vitamin B2), and vitamin B6.
Pellagra develops when the diet is deficient in both niacin and tryptophan, an amino acid that the body can convert into niacin.
The condition primarily affects the skin, gastrointestinal tract, and central nervous system.
Pellagra may also develop in the context of:
Hartnup disease, in which tryptophan absorption is impaired
Carcinoid syndrome, where tryptophan is diverted toward serotonin synthesis rather than niacin production
Chronic alcoholism and isoniazid therapy, both of which can interfere with niacin metabolism or availability
Diagnosis is typically based on dietary history and clinical features. Laboratory confirmation may include measuring niacin metabolites in the urine, although this test is not routinely available. A therapeutic trial of niacin that results in symptom resolution can also support the diagnosis.
Treatment:
The preferred treatment is nicotinamide, a form of niacin that does not cause the flushing, itching, burning, or tingling commonly associated with nicotinic acid.
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Indium
111- tagged white blood cell scan is a type of imaging modality used to help
identify regions of inflammation and thus infections when other imaging studies
are equivocal or contraindicated.
The
test is used for diagnostic purposes in the evaluation of prosthetic joint
infections, osteomyelitis, vascular graft infections, intra-abdominal infections,
abscesses, endocarditis, foot ulcers, infected implanted devices such as
central venous catheters, fevers of unknown origin when there is a high
probability of infection, and Inflammatory bowel disease.
Sensitivity
60 to 100% and specificity 69 to 92%.
White
blood cells are obtained from a blood sample from a patient, are tagged with
the radioisotope indium-111, and then re-injected intravenously into the
patient. These labeled leukocytes localize to a region of inflammation visible
on the whole body or regional nuclear imaging with bone scintigraphy.
Recommended
dose for adults is 0.3 to 0.5 mCi
Prior
IV antibiotics may produce false negative result.
Pneumobilia
Also known as aerobilia. Accumulation of gas in the biliary tree. Seen as linear branching gas within liver most prominent in central large caliber ducts as the flow of bile pushes gas toward the hilum. Gas within the biliary tree tends to be more central, whereas gas within the portal venous system tends to be peripheral (carried along by the blood). Also, biliary gas is anti-dependent, and typically fills the left lobe of the liver.
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“Saber sign”: Supine radiographs often demonstrate a sword-shaped lucency in the right paraspinal region representing gas from the common duct and the left hepatic duct. Present in ~50% of patients with pneumobilia.
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Peripheral small caliber branching gas (lucencies) projected in the liver or vessels coursing towards the Liver (away from the hilum).
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Normal
intestinal fluid transport
Ostomy at ileocecal valve expected to produce 1-1.5 L of stool output/day
Containing
approximately
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In Extensive ileal resection, >100 cm, bile salts loss outpaces hepatic production, leading to bile acid deficiency & steatorrhea
Hypomagnesemia occurs in 78% with a jejunostomy.
Common
complications include:
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Management:
Rehydrate
& replace electrolytes
Oral
hypotonic fluid is restricted & a glucose-saline solution is sipped.
Medication
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Occurs
within one hour of the onset of symptoms.
CAD (most
common 80%)
(Icy
Idiots Chased Hot Vain Chimps)
The
proximal cause of SCD in most instances is either ventricular fibrillation (VF)
or ventricular tachycardia (VT). However, in a significant minority of cases,
asystole or pulseless electrical activity is the initial documented rhythm.
The step to
improving outcomes involves the chain of survival:
References:
