Venous thrombosis after nitrous oxide abuse, a case report

Pratt, David; Patterson, Kevin C.; Quin, Kai

doi:10.1007/s11239-019-02010-9

Cited by 29 publications

(24 citation statements)

References 7 publications

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“…Of these, 30 articles, reporting on 176 patients, were related to recreational N 2 O use while two, reporting on 42 patients, were in the context of N 2 O analgesia for sickle cell crises. Clinical and laboratory features were broadly similar to those reported by Oussalah et al; the majority of patients were young and used N 2 O regularly for recreational purposes with abnormalities seen including myelopathy, encephalopathy, pancytopenia, venous thromboembolic events and rashes 24–29 . Of interest, a rare complication of vitamin B12, which may occur with nitrous oxide toxicity, is optic neuropathy 30 …”

Section: Discussionsupporting

confidence: 69%

Nitrous oxide‐induced neurotoxicity: A case report and literature review

Thayabaran

Burrage

2021

Brit J Clinical Pharma

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Nitrous oxide is an increasingly popular recreational drug. However, recurrent or prolonged use can be associated with nitrous oxide toxicity, with numerous reports of harm documented in the literature. Nitrous oxide irreversibly binds and inactivates vitamin B12, which is an important co-factor in metabolic pathways involved in DNA and myelin synthesis. Toxicity is therefore associated with vitamin B12 deficiencyrelated syndromes, primarily involving haematological and neurological systems. As a "legal high", nitrous oxide use has attracted repeated health warnings from experts.An awareness and understanding of the pathophysiology and management of nitrous oxide toxicity is therefore important for clinicians. We discuss the case of a 29-yearold man presenting with nitrous oxide-induced sensorimotor neuropathy and review the existing literature surrounding toxicity.

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Section: Discussionsupporting

confidence: 69%

Nitrous oxide‐induced neurotoxicity: A case report and literature review

Thayabaran

Burrage

2021

Brit J Clinical Pharma

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“…A major limitation is that we could not screen for all types of hereditary thrombophilia to exclude effects of other unknown conditions. However, considering the close temporal relationship between nitrous oxide use and the incidence of isolated cortical vein thrombosis in our patient who had a clear past history of medical conditions associated with nitrous oxide use, we believe nitrous oxide use had at least partly contributed to the formation of isolated cortical vein thrombosis in our patient despite of scare reports from existing literatures [ 17 – 20 ].…”

Section: Discussionmentioning

confidence: 72%

“…Pratt et al presented a 21-year-old female with a large cerebral venous sinus thrombosis with elevated homocysteine and methylmalonic acid level, normal cobalamin and folate levels. The patient was also pregnant and had significant MTHFR polymorphisms [ 17 ]. Previous studies showed that MTHFR genotype polymorphisms including C677T and A1298C were associated with elevated homocysteine levels [ 26 , 27 ]; homocysteinemia was again associated with increased risk of venous thrombosis [ 28 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

Isolated cortical vein thrombosis after nitrous oxide use in a young woman: a case report

Liu

Zhang

2020

BMC Neurol

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Background Nitrous oxide has become a popular inhalant as abused substance by young Chinese people in recent years. It has been mainly associated with medical conditions including megaloblastic anemia and myeloneuropathy. Case presentation We report a case of a 25-year-old high school graduate who had been abusing nitrous oxide for twenty months. She had a history of peripheral neuropathy and subacute combined degeneration in between. The young woman presented with headache, motor aphasia and right arm paralysis of eight hours after intermittently consuming nitrous oxide for one week. D-dimer was increased (1.1 mg/ml). Blood vitamin B12, folate, homocysteine and beta-HCG levels were normal. Head CT showed hemorrhagic infarction and subarachnoid hemorrhage. MR angiography and venography were normal. Head MRI identified left frontal isolated cortical vein thrombosis. Her muscle strength and verbal fluency significantly improved after initiation of Low Molecular Weight Heparin and serial head MRI showed continuous reduction in the size of thrombus. Conclusions For the first time nitrous oxide use is found to be related to isolated cortical vein thrombosis. Public education regarding the potential consequences of abusing nitrous oxide especially in high-risk individuals is urgently needed.

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“…In 21 cases, total vitamin B12 concentration (either in blood or in serum) was determined. In three case reports [8,33,36] the authors did not report an original B12 value, but reported an interpretation instead (e.g., "vitamin B12 deficiency present"). One article [21] did not provide a reference range, but the B12 concentration (602 pmol/L) did not indicate a deficiency.…”

Section: Resultsmentioning

confidence: 99%

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

Paulus

Wijnhoven

Maessen

et al. 2021

Clinical Toxicology

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Background Recreational use of nitrous oxide (N 2 O) is associated with many side effects, of which neurological complications are most common. Nitrous oxide abuse is also associated with psychiatric symptoms, but these have received less attention so far. Vitamin B12 deficiency may play a role in the development of these psychiatric symptoms. Aims To explore the relationship among the occurrence of recreational nitrous oxide-induced psychiatric symptoms, accompanying neurological symptoms, vitamin B12 status and choice of treatment. Methods A retrospective search for case reports was conducted across multiple databases (Pubmed, Embase, Web of Science, PsycINFO and CINAHL). Keywords included variants of "nitrous oxide", "case report" and "abuse". No restrictions to language or publication date were applied. Results The search retrieved 372 articles. A total of 25 case reports were included, representing 31 patients with psychiatric complications following nitrous oxide abuse. The most often reported symptoms were: hallucinations (n ¼ 16), delusions (n ¼ 11), and paranoia (n ¼ 11). When neurological symptoms were present, patients were treated more frequently with vitamin B12 supplementation. Conclusions This review highlights the need to recognize that psychiatric symptoms may appear in association with nitrous oxide use. Approximately half of the cases that presented with nitrous oxideinduced psychiatric complaints did not show neurological symptoms, and their vitamin B12 concentration was often within the hospital's reference range. Psychiatrists and emergency physicians should be aware of isolated psychiatric symptoms caused by recreational nitrous oxide abuse. We suggest asking all patients with new psychiatric symptoms about nitrous oxide use and protocolizing the management of nitrous oxide-induced psychiatric symptoms.

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Venous thrombosis after nitrous oxide abuse, a case report

Cited by 29 publications

References 7 publications

Nitrous oxide‐induced neurotoxicity: A case report and literature review

Nitrous oxide‐induced neurotoxicity: A case report and literature review

Isolated cortical vein thrombosis after nitrous oxide use in a young woman: a case report

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

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