Vitamin B3 (Niacin) - Quantitative, Serum

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Measures vitamin levels.

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Vitamin B3 (Niacin) - Quantitative, Serum

Why is it done?
- Test Purpose: Measures the serum concentration of niacin (vitamin B3) to assess nutritional status and evaluate for deficiency or toxicity
- Primary Indications: Suspected pellagra (niacin deficiency disease), evaluation of malnutrition or malabsorption disorders, assessment of patients with chronic diarrhea, vomiting, or gastrointestinal dysfunction
- Clinical Scenarios: Patients with alcoholism, inflammatory bowel disease (Crohn's disease or ulcerative colitis), carcinoid syndrome, medication-induced deficiency (isoniazid, 5-fluorouracil), or those on total parenteral nutrition (TPN)
- Monitoring: Patients receiving niacin supplementation therapy or experiencing dermatological, neuropsychiatric, or gastrointestinal symptoms suggestive of deficiency
Normal Range
- Reference Range: 0.8 - 2.5 ng/mL or 6.4 - 20 nmol/L (may vary by laboratory and methodology)
- Units of Measurement: nanograms per milliliter (ng/mL) or nanomoles per liter (nmol/L)
- Normal Values: Levels within the reference range indicate adequate niacin nutritional status and normal metabolic function
- Low Results: Values below 0.8 ng/mL suggest niacin deficiency, requiring further clinical evaluation and possible intervention
- High Results: Values above 2.5 ng/mL may indicate excessive supplementation or niacin toxicity, though levels are typically well-controlled by renal excretion
- Note: Laboratory reference ranges may vary; always consult the specific lab's reference values for accurate interpretation
Interpretation
- Low Niacin Levels (<0.8 ng/mL): Indicates niacin deficiency which may manifest as pellagra (dermatitis, diarrhea, dementia, and death - 'Four Ds'); associated with poor dietary intake, chronic alcoholism, malabsorption conditions, or increased metabolic demands
- Normal Niacin Levels (0.8-2.5 ng/mL): Suggests adequate niacin nutritional status; body maintains niacin through dietary intake and endogenous synthesis from tryptophan
- High Niacin Levels (>2.5 ng/mL): May result from excessive supplementation; chronic high-dose niacin therapy can cause flushing, hepatotoxicity, hyperglycemia, hyperuricemia, and arrhythmias
- Factors Affecting Results:
  - Dietary intake of niacin-rich foods (meat, poultry, fish, nuts, legumes, mushrooms)
  - Endogenous synthesis from tryptophan (an amino acid)
  - Malabsorption conditions (celiac disease, cystic fibrosis, inflammatory bowel disease)
  - Medications: isoniazid (TB treatment), 5-fluorouracil (chemotherapy), phenothiazines, corticosteroids
  - Carcinoid syndrome (increased tryptophan metabolism reduces niacin availability)
  - Chronic alcohol use and liver disease
  - Supplementation therapy and niacin-based medications (used for lipid management)
- Clinical Significance: Niacin serves as a coenzyme in NAD and NADP molecules essential for energy metabolism, DNA repair, and cellular signaling. Deficiency can impair multiple organ systems (dermatological, gastrointestinal, neurological, hematological)
Associated Organs
- Primary Organ Systems:
  - Gastrointestinal tract (esophagus, stomach, intestines) - affected by diarrhea and mucosal inflammation
  - Skin (dermatitis, photosensitivity in exposed areas characteristic of pellagra)
  - Nervous system and brain (neuropsychiatric symptoms, dementia, peripheral neuropathy)
  - Liver and metabolic organs (energy metabolism, hepatotoxicity with excess niacin)
- Associated Diseases and Conditions:
  - Pellagra (niacin deficiency disease) - characterized by dermatitis, diarrhea, dementia, and death
  - Carcinoid syndrome (serotonin-secreting tumors cause excessive tryptophan utilization)
  - Inflammatory bowel diseases (Crohn's disease, ulcerative colitis) - malabsorption
  - Celiac disease and dermatitis herpetiformis - intestinal malabsorption
  - Cystic fibrosis - pancreatic insufficiency and fat malabsorption
  - Chronic alcoholism and liver cirrhosis - poor intake and metabolism
  - Tuberculosis (due to isoniazid therapy) - drug-induced deficiency
  - Hartnup disease (amino acid transport disorder) - reduced tryptophan absorption
- Complications of Abnormal Results:
  - Deficiency: Progressive neurodegeneration, irreversible dementia, severe dermatitis, chronic diarrhea, malnutrition
  - Excess: Hepatotoxicity, hyperglycemia, elevated uric acid levels, cardiac arrhythmias, myopathy
Follow-up Tests
- If Low Niacin Levels Detected:
  - Other B-vitamin panel (B1, B2, B6, B12, folate) - assess for concurrent deficiencies
  - Urinary niacin metabolites - confirm deficiency and monitor supplementation response
  - Liver function tests (ALT, AST, bilirubin) - assess hepatic function
  - Complete blood count (CBC) - evaluate for anemia or other hematologic abnormalities
  - Comprehensive metabolic panel - assess renal and electrolyte status
  - Dietary history and nutritional assessment - identify causative factors
  - Gastrointestinal assessment - if malabsorption suspected (tissue transglutaminase antibodies for celiac disease)
  - 24-hour urine 5-HIAA (5-hydroxyindoleacetic acid) - screen for carcinoid syndrome if indicated
- If High Niacin Levels Detected:
  - Liver function tests - assess for hepatotoxicity from high-dose niacin therapy
  - Fasting glucose and HbA1c - monitor for hyperglycemia
  - Uric acid level - assess for gout risk and hyperuricemia
  - Lipid panel - if niacin used therapeutically, assess efficacy on cholesterol levels
  - Electrocardiography (ECG) - screen for arrhythmias
  - Medication review - adjust niacin supplementation or therapy dosage
- Monitoring Schedule:
  - Initial deficiency: Repeat serum niacin level 4-6 weeks after starting supplementation
  - High-dose therapy: Monitor liver function tests every 3 months and annually thereafter
  - Chronic conditions: Periodic niacin levels as clinically indicated (typically 6-12 months)
- Complementary Diagnostic Tests:
  - NAD/NADP levels - functional assessment of niacin status (research setting)
  - Plasma amino acids including tryptophan - assess tryptophan availability for niacin synthesis
  - Albumin and total protein - assess nutritional status
Fasting Required?
- Fasting Status: No - fasting is NOT required for the serum niacin quantitative test. The test can be performed on a random (non-fasting) blood sample
- Sample Collection: Blood can be drawn at any time of day without dietary restrictions; approximately 5 mL of blood collected in a serum separator tube or standard tube
- Special Instructions:
  - No dietary restrictions needed prior to testing
  - No fluid restrictions required
  - Normal medications may be taken as usual before testing
- Medication Considerations:
  - Do NOT discontinue niacin supplements or therapy before the test; inform phlebotomist and physician of any niacin-containing medications or supplementations
  - Medications that may affect results: Isoniazid, 5-fluorouracil, corticosteroids, phenothiazines (lower levels); niacin itself will elevate levels
- Patient Preparation:
  - Wear comfortable, loose-fitting clothing with easily accessible arm area for venipuncture
  - Remain well-hydrated prior to blood draw (may improve venous access)
  - Arrive at laboratory or healthcare facility with completed requisition and identification
  - Inform phlebotomist of medications, supplements, and any bleeding disorders
- Sample Handling: Blood sample should be processed and separated promptly. Serum must be refrigerated or frozen if not analyzed immediately; stable for limited time at room temperature (typically 2-24 hours, depending on laboratory protocol)

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