Nitrous Oxide–Induced Vitamin B12 Deficiency

Abstract

Nitrous oxide is a gas that is odorless, colorless, and has a sweet taste at room temperature. Nitrous oxide has several uses, including in surgery and dentistry (referred to as "laughing gas"), in automotive racing, and in aerosol spray propellants. The aerosol spray propellants that typically use nitrous oxide are whipped cream canisters and cooking sprays. Unfortunately, these over-the-counter household items are a source of nitrous oxide that can be used for recreational use. The most popular is the use of industrial-grade canisters having the slang term "whippets." The nitrous oxide can be extracted by pushing the nozzle down slightly to the side and catching the released gas with a balloon. The contents of the balloon can then be directly inhaled, giving an instant feeling of euphoria. This is not a benign means to achieve a euphoric state but can cause severe nitrous oxide-induced B12 deficiency, which is presented in this case report.

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

“…30 Since that time case series involving recreational users have been reported internationally, typically in the context of heavy chronic exposure have appeared. 15+16, 23+24+ 31 Rarely presenting with the classic triad of weakness, sore tongue, and paraesthesia, the varied array of non-specific symptoms (including depression, irritability and personality change) can often the lead to the diagnosis being overlooked or 15 The neurological presentation may be diverse however with sensorimotor peripheral neuropathy occurring in the absence of clinical or imaging evidence of myelopathy. 24 Early diagnosis and prompt treatment are required to avoid disease progression and to increase the chance of full recovery, with response to treatment strongly related to the severity and duration of the condition before treatment.…”

“…13 Other mechanisms for the observed neurological sequelae have been proposed including interference with the cytokine F o r P e e r R e v i e w system. 14 Complications attributable to interference with vitamin b12 metabolism 15 have been reported including megaloblastic anaemia, 16 myeloneuropathy, subacute combined degeneration of the cord 18 and reversible psychosis. 19 In previous work, 3 GDS had described current patterns of recreational nitrous oxide use and the 12-month incidence of acute adverse events.…”

Nitrous oxide recreational abuse presenting with myeloneuropathy and mimicking Guillain-Barre syndrome

“…Among psychotic symptoms are anxiety, depression, hallucinations, impulsive and aggressive behaviors, manic delusions, and psychosis (13). Neurological symptoms include weakness, numbness, ataxia, visual symptoms, falls, and paresthesia, confusion, and forgetfulness (14).…”

Hyperbaric oxygen therapy to improve cognitive dysfunction and encephalatrophy induced by N₂O for recreational use: a case report

“…There were several reported cases of the recreational use of N 2 O resulting in myelopathy and polyneuropathy. 7 – 10 The neurological symptoms of these patients were commonly associated with the deficiency of vitamin B 12 . 11 In this case, the reason why the level of vitamin B 12 was high was that the patient received vitamin B 12 treatment after she was found and sent to the Emergency Department of the local hospital in Sydney.…”