Neuropathy After Nitrous Oxide Abuse

Nevins, Michael A.

doi:10.1001/jama.1980.03310200016014

Cited by 34 publications

(9 citation statements)

References 4 publications

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“…The first case report of polyneuropathy associated with the use of ‘whippets’ (slang term for nitrous oxide cartridges used in the catering industry) was made in 1978 (Sahenk et al, 1978). Since that time, case series involving recreational users have been reported internationally, typically in the context of heavy chronic exposure (Cheng et al, 2013; Chiang et al, 2013; Nevins, 1980; Stockton et al, 2017; Thompson et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

Nitrous oxide causes peripheral neuropathy in a dose dependent manner among recreational users

Winstock

Ferris

2019

J Psychopharmacol

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Background: Nitrous oxide (N2O) has been used in clinical and recreational settings for over 150 years. Through inactivation of the Vitamin B12 dependent enzyme, methionine synthase, N2O can lead to the development of peripheral neuropathy. This study sought to determine the relationship between the exposure and risk of neurological symptoms in the largest ever sample of users. Design: Data are drawn from the Global Drug Survey (GDS) over three consecutive years (2014–2016). The Global Drug Survey is an online, cross-sectional survey of substance use, translated into multiple languages. Participants: Respondents to the Global Drug Survey who provided details on N2O use and the experience of paraesthesia in the previous 12 months. Measurements: Questions relating to N2O use, peripheral neuropathy, age and gender were explored among last year’s users. Findings: Of 241,566 respondents, 41,181 (17.0%) indicated that they had ever used nitrous oxide; of these, 42.1% had used in the last 12 months. For the final model, data from 16,124 participants who had used N2O in the last 12 months and had provided responses on age, dose, gender and paraesthesia were used. Of these, the number of respondents reporting persistent numbness/tingling (paraesthesia) in their hands or feet was 537 (3.3%). Although the risk was very low among infrequent users, there was a strong dose–response relationship. For people indicating one or two doses per session, the probability of reporting paraesthesia was approximately 0.018 by comparison; for people indicating 100 doses per session the probability was approximately 0.085. The association, between dose and paraesthesia was influenced by gender and age. Conclusion: While infrequent, episodic users are not at risk, a minority of heavy users are at dose-dependent risk of developing serious neurological consequences. Better education and raised awareness of early symptoms are required.

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Section: Discussionmentioning

confidence: 99%

Nitrous oxide causes peripheral neuropathy in a dose dependent manner among recreational users

Winstock

Ferris

2019

J Psychopharmacol

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“…There have also been case reports of rare fatalities associated with N 2 O use, for example, the less-well-known cases of megaloblastic anaemia and reversible myeloneuropathy. Evidence of a reversible myeloneuropathy in cases of frequent or prolonged exposure, particularly in those working in the dental and surgical fields, (Layzer, 1978; Nevins, 1980; Sahenk et al, 1978) lead to the discovery that N 2 O has multiple effects on cobalamin or vitamin B12 metabolism, primarily through inactivation leading to deficiency and reduced production of deoxyribonucleic acid (Chanarin, 1980; Kondo et al, 1981). The early clinical features of N 2 O-induced myeloneuropathy include patchy tingling and numbness in the hands and feet, loss of manual dexterity, poor balance and leg weakness (Brodsky and Cohen, 1986; Jameson et al, 1999; Vishnubhakat and Beresford, 1991).…”

Section: Introductionmentioning

confidence: 99%

Up: The rise of nitrous oxide abuse. An international survey of contemporary nitrous oxide use

Kaar

Ferris

Waldron³

et al. 2016

J Psychopharmacol

150

180

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In recent years the recreational use of inhaled nitrous oxide gas (N2O) is becoming increasingly popular, yet little is known about the characteristics of its users or the effects they experience. This paper presents original research from the 2014 Global Drug Survey (GDS) (n=74,864). GDS runs the largest survey of recreational drug use in the world. The findings confirm N2O as a very common drug of use, in particular in the UK and US (38.6% and 29.4% lifetime prevalence). In the UK N2O was reported to be the eighth most commonly used substance. N2O was generally consumed via gas-filled balloons, at festivals and clubs where use of other substances was common. The vast majority of users use infrequently, and their use is not associated with significant harm. However, there appears to be a subpopulation of heavy users who may be using in a dependent pattern. Analysis of last year N2O users (n=4883), confirms that N2O is associated with hallucinations and confusion (which may be the desired effects) and persistent numbness and accidental injury (27.8%, 23.9%, 4.3% and 1.2% of last year users, respectively). Accidental injury is associated with the highest number of 'hits' per session, suggesting a dose-response relationship. The presence of significant harm is discussed in the light of public education on the risks of N2O use and harm-reduction strategies appropriate to N2O use. Further work needs to be completed to confirm the presence of persistent neurological symptoms in recreational users.

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“…In 1800 Davy claimed that this gas produces 'a high, an extraordinary degree of pleasure, different from that produced by wine' . 5 Although widely documented amongst dentists, aneasthetists and other health workers with access to medical supplies of nitrous oxide, abuse has also been reported in cases where the gas has been harvested from 'whipped cream bulbs'. 3 -8 In one case, a 15-yearold boy surreptitiously abused nitrous oxide from whipped cream canisters by inhaling the gas in the grocery store without even purchasing the product.…”

Section: Discussionmentioning

confidence: 99%

Nitrous Oxide Abuse in a Community Setting: Case Report

Alderman¹,

Nyfort‐Hansen

2000

The Australian Journal of Hospital Pharmacy

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Nitrous oxide abuse by healthcare practitioners such as dentists and anaesthetists has been extensively described, but recreational use in community settings also occurs. Described here is the case of a 37‐year‐old woman abusing nitrous oxide from charger cartridges for a whipped cream dispenser. The medical and neuropsychiatric sequelae of nitrous oxide abuse are discussed with reference to features observed in this case.

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Neuropathy After Nitrous Oxide Abuse

Abstract: ischémie lactate test" showed lactic acid values in the normal limits, while electromyogram findings and motor conduction velocity were also normal.

Cited by 34 publications

References 4 publications

Nitrous oxide causes peripheral neuropathy in a dose dependent manner among recreational users

Nitrous oxide causes peripheral neuropathy in a dose dependent manner among recreational users

Up: The rise of nitrous oxide abuse. An international survey of contemporary nitrous oxide use

Nitrous Oxide Abuse in a Community Setting: Case Report

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