Mechanism of Action of Nitrous Oxide

Just say N2O – nitrous oxide misuse: essential information for psychiatrists

BJPsych Advances ◽

10.1192/bja.2019.57 ◽

2019 ◽

Vol 26 (2) ◽

pp. 72-81

Author(s):

Rollo J. G. Sheldon ◽

Michael Reid ◽

Frederick Schon ◽

Norman A. Poole

Keyword(s):

Nitrous Oxide ◽

Cognitive Impairment ◽

Mechanism Of Action ◽

Psychiatric Symptoms ◽

Diagnosis And Treatment ◽

Vitamin B ◽

Essential Information ◽

Principles Of Treatment ◽

The Uk

SUMMARYNitrous oxide (N2O) misuse is widespread in the UK. Although it is well-known that it can cause devastating myeloneuropathy, psychiatric presentations are poorly described. There is little understanding of who it affects, how it presents, its mechanism of action and principles of treatment. We begin this article with a case study. We then review the literature to help psychiatrists understand this area and deal with this increasing problem, and make diagnosis and treatment recommendations. We describe a diagnostic pentad of weakness, numbness, paraesthesia, psychosis and cognitive impairment to alert clinicians to the need to urgently treat these patients. Nitrous oxide misuse is a pending neuropsychiatric emergency requiring urgent treatment with vitamin B12 to prevent potentially irreversible neurological and psychiatric symptoms.

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The neuropsychiatric effects of nitrous oxide and low vitamin B12

BJPsych Advances ◽

10.1192/bja.2021.55 ◽

2021 ◽

pp. 1-10

Author(s):

Joseph Farmer ◽

Karen Romain ◽

Mina Ibrahim ◽

Manoj Kumar ◽

William York Moore

Keyword(s):

Nitrous Oxide ◽

Vitamin B12 ◽

Mechanism Of Action ◽

Blood Test ◽

Review Article ◽

Narrative Review ◽

Vitamin B ◽

Correct Interpretation ◽

Neuropsychiatric Complications ◽

Laboratory Results

SUMMARY This narrative review article aims to update knowledge on the neuropsychiatric complications of nitrous oxide use and low vitamin B12. We consider common forms and uses of nitrous oxide (N2O) and review its mechanism of action, and then explore the potential impacts of use. In particular, neuropsychiatric effects mediated by low vitamin B12 are considered and the correct interpretation of laboratory results explored. This is of particular importance as where vitamin B12 is inactivated by chronic nitrous oxide use, blood test levels of vitamin B12 may not reflect the quantity of functional B12 in patients.

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