What was previously known as delirium tremens (DTs) is now known as alcohol withdrawal delirium (AWD). It occurs in some patients on withdrawal of alcohol. The usual treatment is sedation. When sedatives don’t work, other causes of the syndrome must be considered, such as dehydration, head trauma, electrolyte problems, infection, pancreatitis or nutritional abnormalities. Vitamin B deficiencies are a common nutritional problem in people who abuse alcohol, most commonly from thiamine (B-1) deficiency. Patients usually receive a thiamine injection on hospital admission.
For people who don’t respond to thiamine and/or sedatives, pellagra may be the cause. Pellagra is caused by vitamin B-3 (niacin) deficiency. It can cause a delirium that can be confused with alcohol withdrawal, resulting in delay of proper treatment. The authors reported 3 cases of alcohol abuse associated with pellagra.
Symptoms of pellagra include skin rash, diarrhea, and a mental syndrome (often described as a delirium, agitation, or confusion). Patients may have ataxia or rigidity, but rarely do they have all 3 of the above symptoms at the same time. Some patients only have the mental syndrome and never the rash.
Homeless people are at high risk of having nutritional deficiencies as well as a high risk of alcoholism. The frequency of nutritional deficiency in these groups seems to be increasing. They have high rates of food insecurity, and many rely on alcohol for calorie intake. Beer has only a small amount of niacin, and sake has none. Niacin deficiency can be caused by Crohn’s disease and other causes of malabsorption.
The World Health Organization recommends treatment with 300 mg of nicotinamide (form of niacin) in divided doses for 3 or 4 weeks. With treatment, skin and gastrointestinal symptoms may be relieved within 48 hours. Mental symptoms may require several days of treatment to resolve, and they sometimes are permanent. One study showed that, of patients with alcohol dependence who died in the hospital, 27% had pellagra. The fortification of grains and cereals with niacin in the United States has helped to make pellagra quite rare.
CONCLUSION: With alcohol abuse, vitamin B deficiency is always a concern, including vitamin B-3.
NOTE: Pellagrous encephalopathy is the scientific name of a brain syndrome caused by pellagra (niacin deficiency). Niacin is vitamin B-3. The vitamin B’s are water soluble and are easily lost in the urine if not consumed daily.
Rainbow Grocery has the following products: Vitamin B-1 (thiamine), and vitamin B-3 (niacine).
Summary #948. nutrientmedicine