Nicotinamide misuse and overdose
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Nicotinamide misuse and overdose Drug-induced liver injury, vomiting and facial petechiae: case report
A 7-year-old boy developed liver injury, vomiting and facial petechiae following misuse and overdose of nicotinamide during treatment of epilepsy [route and duration of treatment to reaction onset not stated]. The boy, who had epilepsy, was hospitalised due to repeated vomiting (>20 times daily) for two days. He showed facial petechiae, paleness and dehydration. Laboratory results showed an increased level of AST and ALT, and abnormalities of blood coagulation (fibrinogen 148 U/L and INR 2.4). Upon anamnesis, it was found that he was on antiepileptic therapy with lamotrigine and zonisamide. Additionally, he was also administered nicotinamide 4500 mg/day (196 mg/kg body weight daily, 15 fold higher dose than the tolerable upper level), during 4 weeks before hospitalisation, in an attempt to reduce the dose of lamotrigine and zonisamide. The serum nicotinamide level was found be elevated when confirmed analytically. The boy was transferred to the ICU for the treatment. He received supportive therapy consisting of electrolyte, substitution of vitamin K and blood volume repletion. He showed marked improvement within 4 days. He was then discharged 3 days later. Wettstein I, et al. Drug-induced liver injury induced by nicotinamide. Clinical Toxicology 58: 532, No. 6, Jan 2020. Available from: URL: http:// doi.org/10.1080/15563650.2020.1741981 [abstract]
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Reactions 26 Sep 2020 No. 1823
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