The neuropsychiatric effects of nitrous oxide and low vitamin B12

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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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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Encephalitis secondary to nitrous oxide and vitamin B12 deficiency

BMJ Case Reports ◽

10.1136/bcr-2019-229380 ◽

2019 ◽

Vol 12 (12) ◽

pp. e229380

Author(s):

Gareth Hughes ◽

Ed Moran ◽

Martin J Dedicoat

Keyword(s):

Cerebrospinal Fluid ◽

Nitrous Oxide ◽

Peripheral Neuropathy ◽

Vitamin B12 ◽

Tuberculous Meningitis ◽

Vitamin B12 Deficiency ◽

Vitamin B ◽

Severe Vitamin ◽

Elevated Protein ◽

B12 Deficiency

A 27-year-old woman presented with confusion, agitation and fever. Having initially been treated as an infective encephalitis case her initial and subsequent lumbar punctures revealed cerebrospinal fluid with a worsening pleocytosis and elevated protein. It was initially felt she had been suffering from tuberculous meningitis and started on treatment it later became apparent that she had a severe vitamin B12 deficiency related to recreational nitrous oxide use. She also was noted to have a peripheral neuropathy. After replacing her vitamin B12 and later stopping her tuberculous medication once cultures were negative her cognition and peripheral neuropathy continued to improve.

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

Clinical Toxicology ◽

10.1080/15563650.2021.1938107 ◽

2021 ◽

pp. 1-9

Author(s):

Michelle C. Paulus ◽

Anjali M. Wijnhoven ◽

Gerdinique C. Maessen ◽

Shannon R. Blankensteijn ◽

Marcel A. G. van der Heyden

Keyword(s):

Nitrous Oxide ◽

Vitamin B12 ◽

Psychiatric Symptoms ◽

Vitamin B12 Deficiency ◽

Narrative Review ◽

B12 Deficiency

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Molecularly imprinted membrane for transport of urea, creatinine, and vitamin B12 as a hemodialysis candidate membrane

Open Chemistry ◽

10.1515/chem-2021-0069 ◽

2021 ◽

Vol 19 (1) ◽

pp. 806-817

Author(s):

Muhammad Cholid Djunaidi ◽

Nabilah Anindita Febriola ◽

Abdul Haris

Keyword(s):

Polyethylene Glycol ◽

Vitamin B12 ◽

Kidney Function ◽

Cross Linking ◽

Vitamin B ◽

Molecularly Imprinted ◽

Selective Transport ◽

Molecularly Imprinted Membrane ◽

Better Than ◽

Imprinted Membrane

Abstract High levels of urea and creatinine in the blood are a sign of decreased kidney function. To remove these substances from the blood, hemodialysis which utilizes membranes could be used. In this study, a molecularly imprinted membrane (MIM) was synthesized for the selective transport of urea. The synthesis is initiated with the polymerization of eugenol into polyeugenol and then into polyeugenoxy acetate (PA). The PA is then contacted with urea and then used as the functional polymer in the synthesis of MIM with polysulfone as the membrane base, and polyethylene glycol as the cross-linking agent. The result was later analyzed with FTIR and SEM-EDX. The membrane is then used in the transport of urea, creatinine, and vitamin B12 and then compared with the non-imprinted membrane (NIM) performance. By using UV-Vis spectrophotometry, the results showed that the membrane with 10 h heating variation is able to transport more urea and is more selective than NIM; this proves that the urea template on the MIM enables it to recognize urea molecules better than creatinine and vitamin B12. The order of transport from the best results is urea > creatinine > vitamin B12.

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A Narrative Review of Early Oral Stepdown Therapy for the Treatment of Uncomplicated Staphylococcus aureus Bacteremia: Yay or Nay?

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa151 ◽

2020 ◽

Vol 7 (6) ◽

Author(s):

Michael Dagher ◽

Vance G Fowler ◽

Patty W Wright ◽

Milner B Staub

Keyword(s):

Staphylococcus Aureus ◽

Hospital Readmission ◽

Potential Role ◽

Review Article ◽

Narrative Review ◽

Oral Antibiotics ◽

Staphylococcus Aureus Bacteremia ◽

Complete Treatment

Abstract Historically, intravenous (IV) antibiotics have been the cornerstone of treatment for uncomplicated Staphylococcus aureus bacteremia (SAB). However, IV antibiotics are expensive, increase the rates of hospital readmission, and can be associated with catheter-related complications. As a result, the potential role of oral antibiotics in the treatment of uncomplicated SAB has become a subject of interest. This narrative review article aims to summarize key arguments for and against the use of oral antibiotics to complete treatment of uncomplicated SAB and evaluates the available evidence for specific oral regimens. We conclude that evidence suggests that oral step-down therapy can be an alternative for select patients who meet the criteria for uncomplicated SAB and will comply with medical treatment and outpatient follow-up. Of the currently studied regimens discussed in this article, linezolid has the most support, followed by fluoroquinolone plus rifampin.

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Röntgenspektroskopische Bestimmung der Wertigkeit des Kobalts im Vitamin B12

Zeitschrift für Naturforschung B ◽

10.1515/znb-1954-0801 ◽

1954 ◽

Vol 9 (8) ◽

pp. 509-513 ◽

Cited By ~ 24

Author(s):

G. Boehm ◽

A. Faessler ◽

G. Rittmayer

Keyword(s):

Vitamin B12 ◽

Vitamin B

Mit einem fokussierenden Spektrographen großer Dispersion wird die Lage der K-Röntgen-absorptionskante des Kobalts in verschiedenen Verbindungen untersucht. Die Ergebnisse zeigen, daß es möglich ist, durch Bestimmung der Kantenlage die Wertigkeit des Kobalts in einer Verbindung zu bestimmen. Die Methode gestattet den eindeutigen Nachweis, daß das Kobalt im Vitamin B12 dreiwertig ist.

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Influence of Vitamin B12 Status on the Inactivation of Methionine Synthase by Nitrous Oxide

Survey of Anesthesiology ◽

10.1097/00132586-199304000-00007 ◽

1993 ◽

Vol 37 (2) ◽

pp. 63

Author(s):

M. J. LANDON ◽

P. CREAGH-BARRY ◽

S. McARTHUR ◽

A. CHARLETT

Keyword(s):

Nitrous Oxide ◽

Vitamin B12 ◽

Methionine Synthase

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Nitrous Oxide Abuse‐Induced Subacute Combined Degeneration: Classic Neuroimaging Findings on MRI

Neurographics ◽

10.3174/ng.2000063 ◽

2021 ◽

Vol 11 (2) ◽

pp. 72-74

Author(s):

A.K. Kirsch ◽

S.M. Allison ◽

S.A. Kilanowski

Keyword(s):

Spinal Cord ◽

Nitrous Oxide ◽

Mr Imaging ◽

Young Patient ◽

Patient Population ◽

High Signal ◽

Vitamin B ◽

Subacute Combined Degeneration ◽

Dorsal Columns ◽

Delay In Treatment

Subacute combined degeneration is uncommonly a result of nitrous oxide abuse and presents with high signal in the dorsal columns of the spinal cord on T2-weighted MR imaging. We present a case of subacute combined degeneration in a young patient who abused nitrous oxide, which is an uncommon cause and infrequently seen in this patient population. Symptoms are often reversible with treatment of vitamin B12, and radiologists should be aware of these findings to avoid delay in treatment.

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