Vitamin B3 deficiency

Last reviewed: 28 Aug 2023
Last updated: 26 Aug 2020

Summary

Definition

History and exam

Key diagnostic factors

  • dermatitis
  • insomnia, depression, or memory loss
  • intermittent stupor
  • hallucinations or delirium
  • weakness
  • peripheral neuropathy
  • oppositional hypertonus or myoclonus
  • cogwheel rigidity
  • primitive reflexes
  • ataxia
  • nausea, vomiting, or diarrhea
  • glossitis, cheilitis, or stomatitis
More key diagnostic factors

Other diagnostic factors

  • fatigue
  • anxiety or paranoia
  • anorexia, weight loss, or cachexia
  • headache
  • vertigo
  • incontinence
  • constipation
  • heartburn
  • angular palpebritis
Other diagnostic factors

Risk factors

  • malnutrition
  • chronic alcohol use disorder
  • vitamin B2 (riboflavin) deficiency
  • vitamin B6 (pyridoxine) deficiency
  • malabsorption
  • eating disorders
  • Hartnup disease
  • carcinoid syndrome
  • antituberculous drugs
  • Crohn disease
  • HIV infection
  • copper deficiency
  • certain drugs
  • pregnancy and lactation
  • age >65 years
  • Alzheimer dementia
  • Parkinson disease
More risk factors

Diagnostic investigations

1st investigations to order

  • serum tryptophan
  • urinary N-methylnicotinamide
  • urinary N-methyl-2-pyridone-5-carboxamide
  • urinary 2-pyridone/N-methylnicotinamide ratio
  • skin biopsy
  • photosensitivity testing
  • CBC
  • serum albumin
  • serum protein
  • LFTs
  • gamma-GT
More 1st investigations to order

Investigations to consider

  • serum total iron
  • iron-binding capacity
  • ferritin
  • transketolase activity
  • thiamine pyrophosphate (TPP)
  • riboflavin coefficient
  • serum pyridoxal-5-phosphate
  • serum cyanocobalamin
  • serum folic acid
  • red cell folic acid
  • stool exam
  • neutral aminoaciduria
  • serum serotonin
  • platelet serotonin
  • urinary 5-hydroxyindoleacetic acid
  • HIV antibodies
  • mental state exam
  • ECG
More investigations to consider

Treatment algorithm

ACUTE

asymptomatic (marginal deficiency)

symptomatic (pellagra)

Contributors

Authors

Whadi-ah Parker, PhD, RD(SA)

Senior Research Specialist

Centre for the Study of the Social and Environmental Determinants of Nutrition

Population Health, Health Systems and Innovation

HSRC

Cape Town

South Africa

Disclosures

WP declares that she has no competing interests.

Zandile J Mchiza, RD, PhD

Professor

School of Public Health

University of the Western Cape

Cape Town

South Africa

Disclosures

ZJM declares that she has no competing interests.

Demetre Labadarios, MBChB, PhD, FACN

Professor Emeritus

Stellenbosch University

Professor Extraordinaire

University of Limpopo

South Africa

Disclosures

DL declares that he has no competing interests.

Acknowledgements

Dr Whadi-ah Parker, Dr Zandile J Mchiza, and Dr Demetre Labadarios would like to gratefully acknowledge Dr Nelia Patricia Steyn, a previous contributor, as well as Miss Nophiwe Job, Ms Nwabisa Tshefu, and Mr Machoene Derrick Sekgala for their contributions to this topic. NPS, NJ, NT, and MDS declare that they have no competing interests.

Peer reviewers

Alan Shenkin, MB, ChB, BSc, PhD, FRCP, FRCPath

Emeritus Professor of Clinical Chemistry

University of Liverpool

UK

Disclosures

AS declares that he has no competing interests.

Alfredo Morabia, MD, PhD, MS

CBNS

Queens College

City University of New York

NY

Disclosures

AM declares that he has no competing interests.

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