Nitrous Oxide Inhalant Use Disorder Preceding Symptoms Concerning for Primary Psychotic Illness

Abstract

Background and Objective Nitrous oxide has long been used recreationally for its ability to induce euphoria and other deliriant effects. In modern times, it remains a popular, legal, and widely available option for those seeking altered states. Though substance‐induced psychotic symptoms have been mentioned in the literature, the potential long‐term negative neuropsychiatric effects related to its use have not been well established. Methods and Results This is a patient case report of a young man (N = 1) who initially presented with acute neurological symptoms requiring hospitalization due to heavy nitrous oxide inhalant use, and went on to present with symptoms concerning for a primary psychotic illness over multiple inpatient admissions. He provided both verbal and written consent to share his story for this case report. Discussion and Conclusions It is important to consider nitrous oxide use as a possible contributing factor to the development of primary psychotic illness. Scientific Significance Current literature suggests that psychosis associated with nitrous oxide use is transient and resolves upon cessation and treatment of vitamin B12 deficiency. Here, we present a patient with risk factors for psychotic illness developing psychotic illness following extensive nitrous oxide use. This report offers a unique perspective of longitudinal follow‐up (often not provided with reports on this topic), and illustrates the importance of healthcare providers inquiring about nitrous oxide abuse in patients presenting with early psychotic symptoms. (Am J Addict 2020;29:525–527)

Does vitamin B12 deficiency explain psychiatric symptoms in recreational nitrous oxide users? A narrative review

“…In order to prevent neuropsychiatric symptoms, some authors have proposed that the vitamin B12 threshold should be increased to at least 600 pg/mL, which is much higher than the average hospital lower limit [58,59]. In our search three cases presented with a vitamin B12 level in the range of 200-600 pg/mL, cases which would have been missed with the conventional hospital lower limit [11,34,35]. Furthermore, MMA determination in serum could provide additional discriminative information about the cobalamin status [60].…”

Co-Occurring Subacute Combined Degeneration and Guillain-Barré Syndrome Resulting From Nitrous Oxide Abuse: A Case Report

“…Vitamin B 12 deficiency in N 2 O users often presents as SCD with rapid onset [9,14,15]. By definition, this is the degeneration of the posterior and lateral spinal columns [16].…”

“…While some literature suggests full reversibility of neurologic and psychiatric symptoms, several reports have demonstrated that even with vitamin B 12 being repleted intramuscularly, the symptoms are not fully reversible, and patients have residual lifelong symptoms [3,5,14].…”

Non-Opioid Anesthetics Addiction: A Review of Current Situation and Mechanism

“…Long-term exposure to N 2 O can lead to many psychiatric symptoms, such as delusions, delirium, and depression. Apart from psychiatric symptoms, it also causes B 12 deficiency, leading to peripheral neuropathy and megaloblastic anemia [ 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ].…”