The "puzzling dysglycemia" was likely due to dual metabolic effects of niacin. It inhibits breakdown of stored fat, which in the setting of prolonged vomiting would have explained the initial hypoglycemia. Niacin also induces insulin resistance, so correction of hypoglycemia with dextrose "unmasked" this effect leading to hyperglycemia.
Ironically, drug screening tests turned up positive for both patients despite extreme niacin overdose, Dr. Mittal said.
While both patients improved in a few days with supportive care once niacin intake ceased, the cases suggest that healthcare providers should be aware in their differential diagnosis of misguided use of niacin among patients trying to interfere with urine drug screening, the researchers said.
"Emergency physicians should consider attempts to mask urine drug screens as a cause of unusual presentations in high-risk populations, such as military, patients on probation and with a history of drug abuse," Drs. Heard and Mendoza wrote in their editorial.
