A malnourished patient presents with scaling and cracking skin on the arms and face, irritability, anxiety, sleep difficulties, and sore tongue. Teaching about vitamin therapy for this disorder would address which side effects?

• A. Flushing, dizziness, and nausea
• B. Abdominal cramps, diarrhea, migraines
• C. Numbness of extremities
• D. Jaundice or yellowing of the skin and eyes

Answer: (A)

The scenario points to pellagra from niacin deficiency, which is treated with niacin replacement. When teaching about vitamin therapy for this condition, focus on the side effects most commonly seen with niacin. The classic and most important adverse effect to anticipate is flushing of the skin, especially on the face and upper body, often accompanied by warmth, itching, and sometimes dizziness. Nausea can accompany this reaction as well. These effects are well known and frequently occur, especially as therapy is started or dose is increased.

Other listed effects are less characteristic of initial niacin therapy. Abdominal cramps and diarrhea can occur with various B vitamins but are not the hallmark teaching point for niacin. Numbness of extremities isn’t a typical niacin side effect, and jaundice would signal potential liver problems but is not the primary teaching concern with standard niacin dosing.

So, teaching would emphasize that flushing with warmth and itching, along with possible dizziness or nausea, is the expected side effect to monitor and manage when initiating niacin therapy. Practical steps include starting at a low dose, taking with food, and considering pretreatment with an antiplatelet like aspirin to reduce flushing if appropriate, while monitoring for other metabolic effects and liver function at higher doses.