Metabolic Acidosis, Hypoglycemia, and Severe Myalgias

• DOI: 10.1097/pec.0b013e3182131592
• Publication Date: 2011-04-05T04:25:16Z
• Authors: Silvana Arcinegas...; Mary Glas Gaspers; Merlin Channing Lowe
• Keywords: Niacin

Adolescent use of illicit substances remains a significant problem. In attempts to hide their these substances, some are using Internet-recommended methods masking drugs on drug screens, potentially exposing the adolescent severe and possibly dangerous adverse effects. We report 16-year-old patient who ingested approximately 13 g (twenty-six 500-mg tablets) niacin during 48-hour period in an attempt mask his tetrahydrocannabinol upcoming screen. He subsequently developed chest abdominal pain as well extreme diffuse myalgias (previously unreported association with use). addition, he hypoglycemia, acidosis, transaminitis, coagulopathy. required fluid resuscitation bicarbonate infusion. Over 5 days symptoms resolved ultimately did well. Given increasingly available home screens abundance false information readily adolescents via Internet regarding "masking" use, it is likely that cases such ours will become more prevalent. Pediatric emergency physicians pediatricians should maintain high suspicion for or other obscure detection when patients present similar those our patient.