Alcohol pellagra

At present, pellagra is encountered most often in patients with chronic alcoholism, often referred to as alcoholic pellagra encephalopathy (APE). APE patients often show only disturbances of consciousness, but may also manifest myoclonus and ataxia. Administration of niacin is recommended in APE patients showing myoclonus and ataxia even without the classical symptoms found in endemic pellagra patients (Sakai et al., 2006). 

Sakai K, Nakajima T, Fukuhara N (2006) A suspected of alcoholic pellagra encephalopathy with marked response to niacin showing myoclonus and ataxia as chief complaints. No To Shinkei 58(2) 141-144... 

Vitamin B3 is a pyridine compound found in fish, meat, liver, cereal husks, nuts, and pulses. Niacin deficiency produces pellagra, which manifests as dermatitis, diarrhea with enteritis, nausea and vomiting, dementia with headache, insomnia, loss of memory, and disturbances of motor and sensory neurons. Anemia and hypoprotcincrnia are common in pellagra chronic alcoholics have more tendency to suffer from pellagra. Com eaters suffer from pellagra because com... 

Niacin is a nutritional supplement used during periods of deficiency known as pellagra and for the treatment of dyslipidemia. Niacin needs may increase during chronic illness such as diabetes mellitus, malignancy, metabolic diseases, hyperthyroidism, infections, chronic fever, alcoholism, and during pregnancy and lactation. 

Thiamine, a water-soluble vitamin, is indicated in beriberi, anemia secondary to thiamine deficiency, polyneuritis secondary to alcoholism, pregnancy or pellagra, Wernicke s encephalopathy, and wet beri-beri with myocardial failure. 

Documented effects The underground parts have slight antitumor activity. An infusion and alcohol extract are used to treat pellagra and dyspepsia. Fruits are used to treat dyspepsia in children (Belodubrovskaya et al. 2002). 

Symptoms of deficiency. Marginal multiple symptoms such as insomnia, loss of appetite, weight and strength loss, soreness of the tongue and mouth, biurning sensations nervousness, etc. Pellagra dermatosis, dementia, diarrhea. Risk groups alcoholics and people from areas where corn is the major diet. 

When NADP (a phosphate ester of NAD) oxidizes an alcohol to a carbonyl compound, the pyridine ring in the nicotinamide part of the coenzyme is reduced to a dihydropyridine, giving NADPH. The reverse process occurs when NADPH reduces a carbonyl compound to an alcohol. Nicotinic acid is a B vitamin needed for synthesis of this coenzyme. Its deficiency causes the chronic disease pellagra. 

Although pellagra is uncommon, it most frequently afflicts alcoholics and the elderly. Thyrotoxicosis and sepsis increase niacin requirements but rarely precipitate pellagra. Though the disease is produced by dietary insufficiency of tryptophan and niacin, the full deficiency syndrome can develop in patients who shunt tryptophan into other metabolic pathways despite a normal diet. Such is the case for patients with the carcinoid syndrome, in whom 60 times more tryptophan than normal is hydroxy-lated to serotonin (Melmon, 1981). 

As mentioned, some patients have documented deficiencies of several vitamins. Indeed, isolated clinically significant deficiency of a single vitamin is probably rare. Yet the import of multiple deficiencies is not always clear. Even for the best recognized avitaminoses, such as pellagra or the Wernicke-Korsakoff syndrome, defects in cognition are attributable to lack of more than just the one classically implicated vitamin. Deficiency of multiple water soluble vitamins pertains especially to alcoholics, to the elderly, and to severely ill hospitalized patients. For example, low folate stores, combined with inadequate niacin and thiamine, probably contribute to the chronic memory disorder of alcoholism. 

Niacin deficiency leads to unwanted multisystemic problems that are often associated with dermatological changes. Pellagra is a condition in which niacin deficiency causes a symmetrical pigmented rash, thickened skin and superficial scaling which are found in sun-exposed body areas. The classic triad of niacin deficiency are the three D s—dermatitis, diarrhoea and dementia (Hegyi et al. 2004). Some of the effects on the central nervous system include depression, anxiety, restlessness and poor concentration. In addition, alcoholic individuals with poor nutrition can develop pellagroid encephalopathy (Cook et al. 1998). The role of niadn deficiency in cardiovascular disease and lipid metabolism remains to be fully explored. 

Psychiatric manifestations are fairly common but are easily overlooked due to their non-specific nature. These are commonly seen as irritability, poor concentration, anxiety, fatigue, restlessness, apathy and depression. The occurrence of psychosis in pellagra is an uncommon finding, especially as an early feature and we have described it under a separate heading. Additionally, the psychotic spectrum is usually seen in advanced stages of pellagroid encephalopathy, commonly found in chronic alcoholics (Cook et al. 1998). 

Cunha, D.F., Monteiro, J.P., Ortega, L.S., Alves, L.G., and Cunha, S.F., 2000. Serum electrolytes in hospitalized pellagra alcoholics. European Journal of Clinical Nutrition. 54 440-442. 

Ishii, N., and Nishihara, Y., 1981. Pellagra among chronic alcoholics clinical and pathological study of 20 necropsy cases. Journal of Neurology, Neurosurgery Psychiatry. 44 209-215. 

A disease which causes the noninflammatory degeneration of many of the peripheral nerves. It may result from (1) certain deficiency diseases, (2) metabolic diseases, (3) chemical poisoning, (4) some infective diseases, (5) a carcinoma, or (6) some rare genetic diseases. Symptoms consist of cramps, numbness, weakness, loss of reflexes, loss of positional senses, and partial paralysis. Usually the legs are affected first, and then the arms. Those deficiency diseases exhibiting polyneuropathy are beriberi, pellagra, chronic alcoholism, burning feet syndrome, and pyridoxine or pantothenic acid deficiency. 

Deficiency in animals affects the skin and digestive tract. Ruminants on green fodder usually do not require extra niacin, but niacin supplements improve milk yield in cows. Pellagra is a disease resulting from a combined deficiency of niacin and tryptophan. The symptoms of pellagra include dermatosis, dementia, diarrhoea and nervous disorders. Pellagra is rarely seen in industrialized countries and is associated with alcohol abuse. In other parts of the world where maize is the major staple diet, pellagra persists. 

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