Nevertheless, "in the absence of an appropriate medical history, this reaction can be misdiagnosed as anaphylaxis or hypersensitivity reaction and treated inappropriately," Dr. Mittal and colleagues cautioned.
The 14-year-old boy and 17-year-old girl who tried the same thing had worse consequences.
In an attempt to mask marijuana use from his parole officer, the previously healthy boy took 11 tablets of 500-mg timed-release niacin over three days. He arrived at the emergency department with nausea, vomiting, upper abdominal pain, palpitations, and dizziness.
Initially, he had hypoglycemia (26 mg/dL) that then switched to hyperglycemia when he was given dextrose (207 mg/dL). His liver function was abnormal as well with alanine aminotransferase levels that peaked on day four of hospitalization at 344 IU/L (normal range 10 to 45 IU/L) and aspartate aminotransferase levels that peaked on day three at 193 IU/L (normal range 15 to 40 IU/L). He had "impressive neutrophilia" and high-anion-gap metabolic acidosis that resulted in a misdiagnosis of diabetic ketoacidosis.
