A rise in cases of nitrous oxide abuse: neurological complications and biological findings

Abstract

Background The recent lockdown due to the COVID-19 pandemic has been linked to a higher incidence of psychiatric manifestations and substance abuse. The recreative use of nitrous oxide is more and more widespread and neurological complications are frequent. Methods We report clinical characteristics and biological findings of five consecutive patients presenting to our tertiary care center between April 2020 and February 2021 with various neurological symptoms occurring after recent nitrous oxide abuse. Results Our patients presented with subacute combined degeneration of the spinal cord (4/5 patients) or with acute inflammatory demyelinating polyneuropathy (1/5 patients). No patient had reduced vitamin B-12 titer, but all had elevated blood levels of homocysteine and methylmalonic acid. This reflects the functional deficit in vitamin B-12 that can be linked to nitrous oxide consumption. After vitamin B-12 supplementation, clinical signs regressed at least partially in all 5 patients. Conclusion We report an elevated incidence of neurological complications of nitrous oxide abuse occurring during the recent COVID-19 lockdown. Nitrous oxide abuse should be tracked down in patients presenting with compatible neurological symptoms and elevated homocysteinemia. Vitamin B-12 should be supplemented as soon as the diagnosis is made.

Epidemiology, pathophysiology, and classification of the neurological symptoms of post-COVID-19 syndrome

“…Thirdly, brain MRI studies frequently yield normal or nonspecific findings, with no signs of viral encephalitis; however, in some cases, olfactory cortex alterations have been observed in patients with anosmia, 55 while other patients have displayed signs of acute disseminated encephalomyelitis 56 or cytotoxic lesions to the corpus callosum, 57 which may also appear in other types of meningoencephalitis. 58 Leptomeningeal enhancement 59 and nonspecific cortical alterations 60 have been detected in patients admitted to the intensive care unit.…”

Recreational N2O use: just laughing or really bad news?

“…The typical recreational N 2 O user takes ≤5 hits (whippets) in a single session [8] and is unaware of its side-effects [17]. Although incidental N 2 O use is indeed associated with little or no harm, prolonged use of high doses may lead to neurological damage [8], including generalized demyelinating polyneuropathy, resulting in paraesthesia, unsteady gait, weakness and even paralysis because of spinal cord injury [1,2,8,11]. In almost all clinical cases, N 2 O-related neurological symptoms were accompanied by vitamin B 12 (cyanocobalamin) deficiency [1,8,9,18].…”

“…Although general prevalence data are lacking for most countries and N 2 O use is usually not included in general population surveys, there are some indications that problematic N 2 O use is on the rise [1,2,9]. In the United States, the number of N 2 O related cases reported to the Food and Drug Administration (FDA) (FDA Adverse Event Reporting [FAERS] data) increased from 25 in 2012 to 2015 to 99 in 2016 to 2019 [10], which referred in 70% of cases to subjects age 13 to 29 years.…”

“…Improved registration of the N 2 O-related events (e.g. coding) may partly explain the increasing trends in N 2 O related adverse events, but several studies from other countries have shown a similar gradual increase in clinical cases [2,9,11,12].…”

Comparison of Pain in Male Drug Rehabilitees with and without Human Immunodeficiency Virus in Yunnan Province, China

“…Drug use leads to numerous negative outcomes, such as drug use disorders, mental health disorders, human immunodeficiency virus (HIV) infection, hepatitis-related liver cancer and cirrhosis, overdose, and premature death. Drugs are known to modulate the immune system, and drug abusers often face a higher risk of HIV-1 infection, as drugs augment user susceptibility by increasing the number of chemokine receptors present on the cell surface or increasing viral replication [ 1 ]. As the dangers of illicit drugs are well-known, many PWUD are voluntarily attempting to discontinue such drug use; therefore, the health of drug rehabilitees is a major public health concern in Yunnan.…”