Access the full text.
Sign up today, get DeepDyve free for 14 days.
Jy Kang, A. Tinto, J. Higham, A. Majeed (2002)
Peptic ulceration in general practice in England and Wales 1994–98: period prevalence and drug managementAlimentary Pharmacology & Therapeutics, 16
K. Bardhan, M. Williamson, C. Royston, C. Lyon (2004)
Admission rates for peptic ulcer in the trent region, UK, 1972--2000. changing pattern, a changing disease?Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver, 36 9
T. Naka, R. Bellomo (2004)
Bench-to-bedside review: Treating acid–base abnormalities in the intensive care unit – the role of renal replacement therapyCritical Care, 8
Age and Ageing 2006; 35: 448 © The Author 2006. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org Clinical Reminders Table 1. Laboratory tests Two months after A 73-year-old man was admitted to the medical admission Liver tests Normal values On niacin stopping niacin unit with severe metabolic alkalosis (pH 7.62, bicarbonate . ... .... ... .... .... .... .... .... ... .... .... .... .... .... .... ... .... .... .... .... .... .... . T. Bilirubin 0.3–1.5 (mg/dl) 6.9 (mg/dl) 1.0 (mg/dl) 53 mmol/l, base excess +30, chloride 93 μmol/l) and acute Direct Bili 0–0.3 (mg/dl) 4.6 (mg/dl) renal failure (urea 44 mmol/l, creatinine 567 mmol/l) because GGTP 1–50 (U/l) 2,807 (U/l) 68 (U/l) of persistent vomiting. Before 7 years, a narrow pyloric Alkaline canal was noted on endoscopy while he was investigated for phosphotase 37–147 (U/l) 2,315 (U/l) 113 (U/l) weight loss. He took Lansoprazole intermittently for epigas- AST 1–55 (U/l) 127 (U/l) 19 (U/l) tric pain. Shortly after admission, he died from ventricular ALT 5–45 (U/l) 86 (U/l) 25 (U/l) fibrillation. CA19-9 0–36 (U/l) 241 (U/l) 24 (U/l) CEA 0–5 (ng/ml) 22.8 (ng/ml) 5.3 (ng/ml) The prevalence of peptic ulcer disease is decreasing among British population over the years because of Helico- ALT, alanine aminotransferase; AST, aspartate aminotransferase; CA19-9, bacter pylori eradication and widespread use of acid suppres- carbohydrate antigen 19-9; CEA, carcinoembryonic antigen; GGTP, gamma sants [1]. Consequently, elective surgery has also declined glutamyltranspeptidase. dramatically [2]. However, there are older people with com- plications from previous peptic ulcers whose symptoms will remain at bay with proton pump inhibitors. Severe alkalosis because of pyloric stenosis should be managed in a critical patient did have an endoscopic retrograde cholangiopancre- care setting, administering hydrochloric acid through central atography, abdominal computerised tomography scan and venous access [3]. colonoscopy that were normal. The patient later revealed that he was taking non-prescription niacin, which was dis- ABHAY KUMAR DAS*, VIVEKANAND PATIL continued, and the patient’s liver tests, CEA and CA19-9 Pontefract General Infirmary, Medicine for the Elderly, levels returned to normal (Table 1). He continued to Friarwood Lane, Pontefract, WF8 1PL, UK improve and gain weight. *To whom correspondence should be addressed at: Niacin is used to treat certain types of dyslipidaemias [1]. Email: abhaylopa@yahoo.co.uk Flushing, hyperglycaemia, hyperuricaemia, thrombocytope- 1. Kang JY, Tinto A, Higham J et al. Peptic ulceration in general nia, acanthosis nigricans, ichthyosis and hepatic dysfunction practice in England and Wales 1994–98: period prevalence and are some of the adverse effects [2]. Niacin has not been drug management. Aliment Pharmacol Ther 2002; 16:1067–74. reported to cause elevation of tumour-associated antigens 2. Bardhan KD, Williamson M, Royston C et al. Admission rates with symptoms and signs suggestive of underlying malig- for peptic ulcer in the Trent region, UK, 1972–2000: changing nancy. Physicians need to be aware of this rare presentation pattern, a changing disease? Dig Liver Dis 2004; 36:577–88. mimicking malignancy caused by niacin to avoid expensive 3. Naka T, Bellomo R. Bench-to-bedside review: treating acid- and potentially harmful procedures. base abnormalities in the intensive care unit-the role of renal replacement therapy. Crit Care 2004; 8:108–14. 1 2 2 ABRAHAM JOSEPH *, TARUN KOTHARI , SUNDAR VENKATESH doi:10.1093/ageing/afl021 Fairmont Medical Center, 800 Clinic Circle, Fairmont, MN 56031, USA Unity Health System, 1560 Long Pond Road, Rochester, New York, NY 14626, USA Niacin toxicity: a rare presentation *To whom correspondence should be addressed mimicking malignancy at: joseph.abraham@mayo.edu A 79-year-old male patient presented with a 3-month his- 1. Britton ML, Bradberry JC, Letassy NA et al. ASHP therapeutic tory of significant weight loss and jaundice. Liver tests position statement on the safe use of niacin in the manage- revealed significant elevation in alkaline phosphotase, ment of dyslipidemias. American Society of Health-System gamma glutamyltranspeptidase and bilirubin levels. Carci- Pharmacists. Am J Health Syst Pharm 1997; 54: 2815–19. noembryonic antigen (CEA) and carbohydrate antigen 19-9 2. Knopp RH. Drug treatment of lipid disorders. N Engl J Med 1999; 341: 498–511. (CA19-9) levels were also markedly elevated (Table 1). Pain- less jaundice and weight loss with elevated CA19-9 levels in an elderly patient led us to suspect pancreatic cancer. The doi:10.1093/ageing/afl029
Age and Ageing – Oxford University Press
Published: Jul 1, 2006
You can share this free article with as many people as you like with the url below! We hope you enjoy this feature!
Read and print from thousands of top scholarly journals.
Already have an account? Log in
Bookmark this article. You can see your Bookmarks on your DeepDyve Library.
To save an article, log in first, or sign up for a DeepDyve account if you don’t already have one.
Copy and paste the desired citation format or use the link below to download a file formatted for EndNote
Access the full text.
Sign up today, get DeepDyve free for 14 days.
All DeepDyve websites use cookies to improve your online experience. They were placed on your computer when you launched this website. You can change your cookie settings through your browser.