Nitrous oxide inhalant abuse and massive pulmonary embolism in COVID-19

Molina, Melanie F.; Saud, Ahad Alhassan Al; Mulhim, Abdullah A. Al; Liteplo, Andrew S.; Shokoohi, Hamid

doi:10.1016/j.ajem.2020.05.023

Cited by 16 publications

(4 citation statements)

References 7 publications

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“…These estimates are consistent with the potential severity and complicated management of incident cases due to a series of factors that could be underscored by professionals unfamiliar with N 2 O abuse [1,12,20,[64][65][66]. For one, even though the large majority of N 2 O users does not reasonably develop any significant complication, a reduced but noticeable proportion of cases can be complicated by hypercoagulability associated with secondary hyperhomocysteinemia [1,20,[64][65][66][67][68][69], leading to deep vein thrombosis and potentially life-threatening conditions such as cerebral venous sinus thrombosis [13,66,[70][71][72] and pulmonary embolism [64,[67][68][69]. Second, the available data suggest that a substantial share of incident cases eventually fails to cope with rehabilitation for a variety of different causes, including the lack of support from familiars of social services or a pre-existing, complicated background of multiple substance abuse [14,23,[73][74][75][76].…”

Section: Summary Of Key Resultssupporting

confidence: 67%

Nitrous Oxide Inhalant Abuse: Preliminary Results from a Cross-Sectional Study on Knowledge, Attitudes, and Practices of Italian Physicians (2023)

Riccò,

Ferraro,

Corrado

et al. 2023

Medicina

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Background and Objectives: Nitrous oxide (N2O) has recently emerged as a cheap alternative to other recreational substances. Although legally available, its chronic use is associated with severe neurological and hematological complications due to the irreversible inactivation of vitamin B12. While no reliable data on abuse of N2O in Italy have been provided to date, we assessed the knowledge, attitudes, and practices of Italian medical professionals on the management of N2O abuse cases. Materials and Methods: A cross-sectional study was performed as a web-based survey through a series of Facebook discussion groups (targeted medical professionals: 12,103), and participants were specifically asked about their previous understanding of N2O abuse and whether they had or not any previous experience in this topic. Results: A total 396 medical professionals participated in the survey. Overall, 115 participants had previous knowledge about N2O abuse (29.04%), with higher odds for professionals with a background in emergency medicine (adjusted odds ratio (aOR) 3.075; 95% confidence intervals (95%CI) 1.071 to 8.828) and lower for specialists in psychiatry (aOR 0.328; 95%CI 0.130 to 0.825). Knowledge status on N2O abuse was largely unsatisfying, as knowledge status, reported as a percent value, was estimated to 45.33% ± 24.71. Having previously managed a case of N2O abuse was associated with higher risk perception of the actual severity of this condition (aOR 5.070; 95%CI 1.520 to 16.980). Conclusions: Our study suggests that N2O poisoning cases are occurring in Italian settings but are not reasonably reported to national authorities. As substantial knowledge gaps of Italian medical workforces were identified, we cannot rule out that the actual abuse of N2O in the population may be far larger than currently suspected.

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Section: Summary Of Key Resultssupporting

confidence: 67%

Nitrous Oxide Inhalant Abuse: Preliminary Results from a Cross-Sectional Study on Knowledge, Attitudes, and Practices of Italian Physicians (2023)

Riccò,

Ferraro,

Corrado

et al. 2023

Medicina

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“…Although the use of N 2 O is not associated with significant harm, the adverse effects of N 2 O abuse are well known to include neurologic sequelae such as myeloneuropathy and subacute combined degeneration, as well as psychiatric effects such as psychosis and mood changes [ 5 , 6 ]. Other medical effects such as pneumomediastinum [ 7 ], venous thrombosis [ 8 ], pulmonary embolism [ 9 ], and even death have been reported [ 10 , 11 ]. However, there are few reports regarding the clinical manifestations of N 2 O users when they present to the emergency department (ED).…”

Section: Introductionmentioning

confidence: 99%

The Clinical Presentations of Nitrous Oxide Users in an Emergency Department

Lin

Gao

Lin

2022

Toxics

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Today, the concomitant abuse of nitrous oxide (N2O) and illicit drugs is evident and problematic. However, there are few reports regarding the clinical manifestations of N2O users when they present to the emergency department (ED). The purpose of this study was to describe the clinical presentations, the associated illicit substances used in combination, and the outcomes in N2O users visiting the ED. This was a retrospective observational cohort study. All N2O adult users admitted to the ED at Linkou Chang Gung Memorial Hospital between 2012 and 2020 were included. Demographic variables, clinical symptoms, and examination results were collected from medical records. Univariate comparisons were conducted between pure N2O users and combined illicit drug users. A total of 40 patients were included, 24 of which were pure N2O users. Limb weakness and numbness accounted for the majority of chief complaints. Neurologic symptoms were the most common clinical manifestations (90%). A more severe ED triage level, faster heart rate, greater agitation, and cardiovascular symptoms were significantly noted in combined illicit drug users. In ED, limb numbness/weakness should arouse physicians’ awareness of patients using N2O. Combined use of N2O and illicit drugs can cause great harm to health.

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“…The grey literature search located no additional sources. Altogether, the evidence in this review includes 117 case reports/series 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 28 observational studies 10 , 11 , 139 , 140 , 141 , 142 , 143 , 144 , 145 , 146 , 147 , 148 , 149 , 150 , 151 , 152 , 153 , 154 , 155 , 156 , 157 , 158 , 159 , 160 , 161 , 162 , 163...…”

Section: Resultsmentioning

confidence: 99%