Nicotinamide as a Cause of Severe Acute Hepatocellular Injury

ABSTRACT

Dietary supplements are widely perceived as safe, yet high-dose ingestion can cause severe toxicity. We report a 20-year-old woman who developed acute hepatocellular injury following intentional ingestion of 15 g nicotinamide. She presented with vomiting, epigastric pain, and transient hypotension. Liver function tests rapidly deteriorated with a marked transaminitis, with associated coagulopathy. There was no hepatic encephalopathy. Extensive investigations for viral, autoimmune, metabolic, and vascular causes were unrevealing. She improved with supportive care, including N-acetylcysteine, vitamin K, and electrolyte replacement. This case highlights nicotinamide overdose as an important and potentially under-recognized cause of severe acute liver injury.