Niacin toxicity resulting from urine drug test evasion.
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.


OBJECTIVE
The aim of this article is to describe a unique clinical presentation of niacin toxicity.


METHODS
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.


CONCLUSIONS
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.
Daul
Anne M
AM
Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina 28203, USA.
Beuhler
Michael C
MC
D058186:Acute Kidney Injury / Q000139:chemically induced*; D003692:Delayed-Action Preparations / Q000506:poisoning; D004211:Disseminated Intravascular Coagulation / Q000139:chemically induced*; D062787:Drug Overdose; D006801:Humans; D020407:Internet; D008297:Male; D009525:Niacin / Q000506:poisoning*; D010353:Patient Education as Topic / Q000592:standards; D011697:Purpura, Thrombotic Thrombocytopenic / Q000139:chemically induced*; D015813:Substance Abuse Detection; D055815:Young Adult
D003692:Delayed-Action Preparations; D009525:Niacin