Pellagra and Alcohol Dependence Syndrome: Findings From a Tertiary Care Addiction Treatment Centre in India
Pellagra diagnosed according to skin lesions and response to niacin was diagnosed in 1% of 2947 patients admitted to an Indian alcohol treatment centre. Of the classical symptom triad, 58% had delirium and 19% had diarrhoea. Half had a body mass index
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| Veröffentlicht in: | Alcohol and alcoholism (Oxford) 2019-03, Vol.54 (2), p.148-151 |
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| creator | Narasimha, Venkata Lakshmi Ganesh, Suhas Reddy, Sarath Shukla, Lekhansh Mukherjee, Diptadhi Kandasamy, Arun Chand, Prabhat K Benegal, Vivek Murthy, Pratima |
| description | Pellagra diagnosed according to skin lesions and response to niacin was diagnosed in 1% of 2947 patients admitted to an Indian alcohol treatment centre. Of the classical symptom triad, 58% had delirium and 19% had diarrhoea. Half had a body mass index |
| doi_str_mv | 10.1093/alcalc/agz004 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2213155944</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/alcalc/agz004</oup_id><sourcerecordid>2213155944</sourcerecordid><originalsourceid>FETCH-LOGICAL-c326t-286bec46f14f4a0257daf1c0284cb30f76e5b9164af635a355d59a7c46465d5b3</originalsourceid><addsrcrecordid>eNqFUD1PwzAQtRCIlsLIijyyhPozadiqQqFSJZAoc-TYlxJInGAnQ_n1uEqBEel0H7r33ukeQpeU3FCS8qmqdIip2n4RIo7QmIpYRFwSdozGJOEyIoKKETrz_p0QKjijp2jEScJomvIx-niGqlJbp7CyBs8r3bw1Fb6DFqwBqwG_7KxxTQ23eFlaU9qtx8swY4U34LpSuR1eKAd4bkypu7KxeONAdTXYDi9CCqvS4lWgqnN0UqjKw8WhTtDr8n6zeIzWTw-rxXwdac7iLmKzOAct4oKKQijCZGJUQTVhM6FzTookBpmnNBaqiLlUXEojU5UEhohDm_MJuh50W9d89uC7rC693v9poel9xhjlVMpUiACNBqh2jfcOiqx1ZR2eyijJ9v5mg7_Z4G_AXx2k-7wG84v-MfTvdtO3_2h9A7j8hXw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2213155944</pqid></control><display><type>article</type><title>Pellagra and Alcohol Dependence Syndrome: Findings From a Tertiary Care Addiction Treatment Centre in India</title><source>Oxford University Press Journals All Titles (1996-Current)</source><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Alma/SFX Local Collection</source><creator>Narasimha, Venkata Lakshmi ; Ganesh, Suhas ; Reddy, Sarath ; Shukla, Lekhansh ; Mukherjee, Diptadhi ; Kandasamy, Arun ; Chand, Prabhat K ; Benegal, Vivek ; Murthy, Pratima</creator><creatorcontrib>Narasimha, Venkata Lakshmi ; Ganesh, Suhas ; Reddy, Sarath ; Shukla, Lekhansh ; Mukherjee, Diptadhi ; Kandasamy, Arun ; Chand, Prabhat K ; Benegal, Vivek ; Murthy, Pratima</creatorcontrib><description>Pellagra diagnosed according to skin lesions and response to niacin was diagnosed in 1% of 2947 patients admitted to an Indian alcohol treatment centre. Of the classical symptom triad, 58% had delirium and 19% had diarrhoea. Half had a body mass index <18.5 kg/m2. Full recovery from the syndrome was seen.
Abstract
Aim
To define the prevalence and clinical presentation of pellagra, a multi-systemic disease caused by the deficiency of niacin, in patients admitted to a tertiary addiction treatment centre in southern India, with alcohol dependence syndrome (ADS)—(ICD10).
Methods
Review of the health records of 2947 patients who received inpatient care for ADS between 2015 and 2017.
Results
Out of 2947, 31 (1%) were diagnosed with pellagra. Nearly two-thirds (64.5%) of those with pellagra were from a low-income group. Of the clinical-triad of pellagra, all patients had dermatitis, more than half (58%) had delirium, a minority (19%) had diarrhoea. Nearly two-thirds (61%) had presented in a complicated-withdrawal state. Associated conditions included peripheral neuropathy (32%); Wernicke’s encephalopathy (26%); seizures (16%).
Seventeen (54%) had BMI <18.5 kg/m2. Treatment was a high dose of parenteral vitamins including niacin (mean dose: 1500 mg/day) for an average of 7.5 days followed by oral multivitamin supplements. All had complete resolution of pellagrous symptoms by the end of the three weeks of inpatient care.
Conclusions
Pellagra is an acute medical condition, frequently encountered in the context of alcohol dependence and poverty. It often presents with other disabling and life-threatening comorbidities like delirium tremens and Wernicke’s encephalopathy. The classical triad of pellagra is only seen in a minority of cases. Thus a high index of suspicion is required lest pellagra may remain undiagnosed. Prompt identification and treatment with a high dose of niacin in combination with other vitamins result in complete recovery.</description><identifier>ISSN: 0735-0414</identifier><identifier>EISSN: 1464-3502</identifier><identifier>DOI: 10.1093/alcalc/agz004</identifier><identifier>PMID: 30721993</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Adult ; Alcohol Withdrawal Delirium - epidemiology ; Alcoholism - complications ; Alcoholism - epidemiology ; Comorbidity ; Humans ; India - epidemiology ; Korsakoff Syndrome - complications ; Korsakoff Syndrome - epidemiology ; Niacin - therapeutic use ; Pellagra - complications ; Pellagra - diagnosis ; Pellagra - drug therapy ; Pellagra - epidemiology ; Poverty - statistics & numerical data ; Prevalence ; Substance Abuse Treatment Centers - statistics & numerical data ; Tertiary Healthcare - statistics & numerical data ; Vitamins - therapeutic use ; Young Adult</subject><ispartof>Alcohol and alcoholism (Oxford), 2019-03, Vol.54 (2), p.148-151</ispartof><rights>The Author(s) 2019. Medical Council on Alcohol and Oxford University Press. All rights reserved. 2019</rights><rights>The Author(s) 2019. Medical Council on Alcohol and Oxford University Press. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c326t-286bec46f14f4a0257daf1c0284cb30f76e5b9164af635a355d59a7c46465d5b3</citedby><cites>FETCH-LOGICAL-c326t-286bec46f14f4a0257daf1c0284cb30f76e5b9164af635a355d59a7c46465d5b3</cites><orcidid>0000-0001-9111-8714</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,1578,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30721993$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Narasimha, Venkata Lakshmi</creatorcontrib><creatorcontrib>Ganesh, Suhas</creatorcontrib><creatorcontrib>Reddy, Sarath</creatorcontrib><creatorcontrib>Shukla, Lekhansh</creatorcontrib><creatorcontrib>Mukherjee, Diptadhi</creatorcontrib><creatorcontrib>Kandasamy, Arun</creatorcontrib><creatorcontrib>Chand, Prabhat K</creatorcontrib><creatorcontrib>Benegal, Vivek</creatorcontrib><creatorcontrib>Murthy, Pratima</creatorcontrib><title>Pellagra and Alcohol Dependence Syndrome: Findings From a Tertiary Care Addiction Treatment Centre in India</title><title>Alcohol and alcoholism (Oxford)</title><addtitle>Alcohol Alcohol</addtitle><description>Pellagra diagnosed according to skin lesions and response to niacin was diagnosed in 1% of 2947 patients admitted to an Indian alcohol treatment centre. Of the classical symptom triad, 58% had delirium and 19% had diarrhoea. Half had a body mass index <18.5 kg/m2. Full recovery from the syndrome was seen.
Abstract
Aim
To define the prevalence and clinical presentation of pellagra, a multi-systemic disease caused by the deficiency of niacin, in patients admitted to a tertiary addiction treatment centre in southern India, with alcohol dependence syndrome (ADS)—(ICD10).
Methods
Review of the health records of 2947 patients who received inpatient care for ADS between 2015 and 2017.
Results
Out of 2947, 31 (1%) were diagnosed with pellagra. Nearly two-thirds (64.5%) of those with pellagra were from a low-income group. Of the clinical-triad of pellagra, all patients had dermatitis, more than half (58%) had delirium, a minority (19%) had diarrhoea. Nearly two-thirds (61%) had presented in a complicated-withdrawal state. Associated conditions included peripheral neuropathy (32%); Wernicke’s encephalopathy (26%); seizures (16%).
Seventeen (54%) had BMI <18.5 kg/m2. Treatment was a high dose of parenteral vitamins including niacin (mean dose: 1500 mg/day) for an average of 7.5 days followed by oral multivitamin supplements. All had complete resolution of pellagrous symptoms by the end of the three weeks of inpatient care.
Conclusions
Pellagra is an acute medical condition, frequently encountered in the context of alcohol dependence and poverty. It often presents with other disabling and life-threatening comorbidities like delirium tremens and Wernicke’s encephalopathy. The classical triad of pellagra is only seen in a minority of cases. Thus a high index of suspicion is required lest pellagra may remain undiagnosed. Prompt identification and treatment with a high dose of niacin in combination with other vitamins result in complete recovery.</description><subject>Adult</subject><subject>Alcohol Withdrawal Delirium - epidemiology</subject><subject>Alcoholism - complications</subject><subject>Alcoholism - epidemiology</subject><subject>Comorbidity</subject><subject>Humans</subject><subject>India - epidemiology</subject><subject>Korsakoff Syndrome - complications</subject><subject>Korsakoff Syndrome - epidemiology</subject><subject>Niacin - therapeutic use</subject><subject>Pellagra - complications</subject><subject>Pellagra - diagnosis</subject><subject>Pellagra - drug therapy</subject><subject>Pellagra - epidemiology</subject><subject>Poverty - statistics & numerical data</subject><subject>Prevalence</subject><subject>Substance Abuse Treatment Centers - statistics & numerical data</subject><subject>Tertiary Healthcare - statistics & numerical data</subject><subject>Vitamins - therapeutic use</subject><subject>Young Adult</subject><issn>0735-0414</issn><issn>1464-3502</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFUD1PwzAQtRCIlsLIijyyhPozadiqQqFSJZAoc-TYlxJInGAnQ_n1uEqBEel0H7r33ukeQpeU3FCS8qmqdIip2n4RIo7QmIpYRFwSdozGJOEyIoKKETrz_p0QKjijp2jEScJomvIx-niGqlJbp7CyBs8r3bw1Fb6DFqwBqwG_7KxxTQ23eFlaU9qtx8swY4U34LpSuR1eKAd4bkypu7KxeONAdTXYDi9CCqvS4lWgqnN0UqjKw8WhTtDr8n6zeIzWTw-rxXwdac7iLmKzOAct4oKKQijCZGJUQTVhM6FzTookBpmnNBaqiLlUXEojU5UEhohDm_MJuh50W9d89uC7rC693v9poel9xhjlVMpUiACNBqh2jfcOiqx1ZR2eyijJ9v5mg7_Z4G_AXx2k-7wG84v-MfTvdtO3_2h9A7j8hXw</recordid><startdate>20190301</startdate><enddate>20190301</enddate><creator>Narasimha, Venkata Lakshmi</creator><creator>Ganesh, Suhas</creator><creator>Reddy, Sarath</creator><creator>Shukla, Lekhansh</creator><creator>Mukherjee, Diptadhi</creator><creator>Kandasamy, Arun</creator><creator>Chand, Prabhat K</creator><creator>Benegal, Vivek</creator><creator>Murthy, Pratima</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-9111-8714</orcidid></search><sort><creationdate>20190301</creationdate><title>Pellagra and Alcohol Dependence Syndrome: Findings From a Tertiary Care Addiction Treatment Centre in India</title><author>Narasimha, Venkata Lakshmi ; Ganesh, Suhas ; Reddy, Sarath ; Shukla, Lekhansh ; Mukherjee, Diptadhi ; Kandasamy, Arun ; Chand, Prabhat K ; Benegal, Vivek ; Murthy, Pratima</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c326t-286bec46f14f4a0257daf1c0284cb30f76e5b9164af635a355d59a7c46465d5b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adult</topic><topic>Alcohol Withdrawal Delirium - epidemiology</topic><topic>Alcoholism - complications</topic><topic>Alcoholism - epidemiology</topic><topic>Comorbidity</topic><topic>Humans</topic><topic>India - epidemiology</topic><topic>Korsakoff Syndrome - complications</topic><topic>Korsakoff Syndrome - epidemiology</topic><topic>Niacin - therapeutic use</topic><topic>Pellagra - complications</topic><topic>Pellagra - diagnosis</topic><topic>Pellagra - drug therapy</topic><topic>Pellagra - epidemiology</topic><topic>Poverty - statistics & numerical data</topic><topic>Prevalence</topic><topic>Substance Abuse Treatment Centers - statistics & numerical data</topic><topic>Tertiary Healthcare - statistics & numerical data</topic><topic>Vitamins - therapeutic use</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Narasimha, Venkata Lakshmi</creatorcontrib><creatorcontrib>Ganesh, Suhas</creatorcontrib><creatorcontrib>Reddy, Sarath</creatorcontrib><creatorcontrib>Shukla, Lekhansh</creatorcontrib><creatorcontrib>Mukherjee, Diptadhi</creatorcontrib><creatorcontrib>Kandasamy, Arun</creatorcontrib><creatorcontrib>Chand, Prabhat K</creatorcontrib><creatorcontrib>Benegal, Vivek</creatorcontrib><creatorcontrib>Murthy, Pratima</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Alcohol and alcoholism (Oxford)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Narasimha, Venkata Lakshmi</au><au>Ganesh, Suhas</au><au>Reddy, Sarath</au><au>Shukla, Lekhansh</au><au>Mukherjee, Diptadhi</au><au>Kandasamy, Arun</au><au>Chand, Prabhat K</au><au>Benegal, Vivek</au><au>Murthy, Pratima</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pellagra and Alcohol Dependence Syndrome: Findings From a Tertiary Care Addiction Treatment Centre in India</atitle><jtitle>Alcohol and alcoholism (Oxford)</jtitle><addtitle>Alcohol Alcohol</addtitle><date>2019-03-01</date><risdate>2019</risdate><volume>54</volume><issue>2</issue><spage>148</spage><epage>151</epage><pages>148-151</pages><issn>0735-0414</issn><eissn>1464-3502</eissn><abstract>Pellagra diagnosed according to skin lesions and response to niacin was diagnosed in 1% of 2947 patients admitted to an Indian alcohol treatment centre. Of the classical symptom triad, 58% had delirium and 19% had diarrhoea. Half had a body mass index <18.5 kg/m2. Full recovery from the syndrome was seen.
Abstract
Aim
To define the prevalence and clinical presentation of pellagra, a multi-systemic disease caused by the deficiency of niacin, in patients admitted to a tertiary addiction treatment centre in southern India, with alcohol dependence syndrome (ADS)—(ICD10).
Methods
Review of the health records of 2947 patients who received inpatient care for ADS between 2015 and 2017.
Results
Out of 2947, 31 (1%) were diagnosed with pellagra. Nearly two-thirds (64.5%) of those with pellagra were from a low-income group. Of the clinical-triad of pellagra, all patients had dermatitis, more than half (58%) had delirium, a minority (19%) had diarrhoea. Nearly two-thirds (61%) had presented in a complicated-withdrawal state. Associated conditions included peripheral neuropathy (32%); Wernicke’s encephalopathy (26%); seizures (16%).
Seventeen (54%) had BMI <18.5 kg/m2. Treatment was a high dose of parenteral vitamins including niacin (mean dose: 1500 mg/day) for an average of 7.5 days followed by oral multivitamin supplements. All had complete resolution of pellagrous symptoms by the end of the three weeks of inpatient care.
Conclusions
Pellagra is an acute medical condition, frequently encountered in the context of alcohol dependence and poverty. It often presents with other disabling and life-threatening comorbidities like delirium tremens and Wernicke’s encephalopathy. The classical triad of pellagra is only seen in a minority of cases. Thus a high index of suspicion is required lest pellagra may remain undiagnosed. Prompt identification and treatment with a high dose of niacin in combination with other vitamins result in complete recovery.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>30721993</pmid><doi>10.1093/alcalc/agz004</doi><tpages>4</tpages><orcidid>https://orcid.org/0000-0001-9111-8714</orcidid></addata></record> |
| fulltext | fulltext |
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| ispartof | Alcohol and alcoholism (Oxford), 2019-03, Vol.54 (2), p.148-151 |
| issn | 0735-0414 1464-3502 |
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| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Adult Alcohol Withdrawal Delirium - epidemiology Alcoholism - complications Alcoholism - epidemiology Comorbidity Humans India - epidemiology Korsakoff Syndrome - complications Korsakoff Syndrome - epidemiology Niacin - therapeutic use Pellagra - complications Pellagra - diagnosis Pellagra - drug therapy Pellagra - epidemiology Poverty - statistics & numerical data Prevalence Substance Abuse Treatment Centers - statistics & numerical data Tertiary Healthcare - statistics & numerical data Vitamins - therapeutic use Young Adult |
| title | Pellagra and Alcohol Dependence Syndrome: Findings From a Tertiary Care Addiction Treatment Centre in India |
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