The dangers of recreational inhalation of nitrous oxide

2021 ◽  
pp. 1-8
Author(s):  
Joshua Wong ◽  
Thevarajah Viyasar ◽  
Benjamin Layton ◽  
Joshua Lauder
Keyword(s):  
Nitrous Oxide ◽  
Psychosocial Interventions ◽  
Complete Recovery ◽  
Clinical Findings ◽  
Vitamin B ◽  
Alveolar Pressure ◽  
Subacute Combined Degeneration ◽  
System A ◽  
Laughing Gas ◽  
The Uk

Nitrous oxide, also known as ‘laughing gas’, is one of the most widely used recreational drugs among teenagers in the UK. Copious inhalation of nitrous oxide may increase intra-alveolar pressure, resulting in barotrauma secondary to alveolar rupture. Pneumomediastinum and subcutaneous emphysema are common clinical findings in nitrous oxide-associated barotrauma. Prolonged nitrous oxide misuse may inactivate vitamin B12 through the alteration of its metabolism, causing demyelination of the central and peripheral nervous system. A spectrum of neurological manifestations has been reported, including peripheral neuropathy, myelopathy and subacute combined degeneration of the spinal cord. Medical therapies and psychosocial interventions aiming at nitrous oxide cessation are important treatment steps to achieve partial or complete recovery from the adverse effects associated with inhalation of nitrous oxide.

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

Neurographics ◽  
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.

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

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.

scholarly journals Neurological complications and pathogenetic therapy for chronic nitrous oxide intoxication (“laughing gas”) in nightclub visitors

2020 ◽  
Vol 10 (3) ◽  
pp. 49-62
Author(s):  
N. А. Suponeva ◽  
D. А. Grishina ◽  
D. А. Grozova ◽  
N. V. Belova ◽  
М. А. Ginzberg ◽  
...  
Keyword(s):  
Nitrous Oxide ◽  
Neurological Complication ◽  
Neurological Complications ◽  
Vitamin B ◽  
Aged People ◽  
Laughing Gas ◽  
Pathogenetic Therapy ◽  
Vitamin Level ◽  
Sensory Polyneuropathy

Background. Nitrous oxide abuse (“laughing gas”, N2O) is common among young people attending nightclubs. Contrary to popular belief about the safety of N2O, in some cases neurological complications develop due to a deficiency of vitamin B12, the activity of which is blocked by N2O. Purpose of the study – to determine the typology and course of neurological disorders in a group of patients who regularly use “laughing gas”. To note the key diagnostic markers that allow verification of vitamin B12 deficiency induced by nitrous oxide consumption. To describe pathogenetic therapy features and follow-up. Materials and methods. The study included 12 patients (10 men and 2 women) aged 18 to 45 years (average age 29 years) with a diagnosis of B12-deficient myelopolyneuropathy induced by regular use of nitrous oxide. Results. The most common neurological complication of nitrous oxide abuse for more than 1 month was a generalized lesion of the peripheral nerves with acute or subacute distal symmetric sensory or sensorimotor axonal polyneuropathy. In the clinical picture, sensory complaints and disorders prevailed. Paresis developed in half of the cases. A typical neuroimaging symptom characteristic of funicular myelosis was rarely detected (16.7 %). A decrease in B12 vitamin level could most reliably be diagnosed only indirectly, by the presence of hyperhomocysteinemia (91.7 % of cases). In all cases that were followed-up, prolonged therapy with cyanocobalamin led to partial (n = 5; 62.5 %) or complete (n = 3; 37.5 %) regression of neurological symptoms. Conclusion. Caution regarding the use of nitrous oxide should be in all cases of predominantly sensory polyneuropathy with acute or subacute development in young and middle-aged people. A thorough history taking (targeted survey on the fact of nitrous oxide consumption) and diagnostics (testing the level of homocysteine, if possible methylmalonic acid) allow you to not miss a deficiency of vitamin B12, the treatment of the consequences of which with timely verification and adequate correction is quite effective. It is recommended that the level of homocysteine in the blood to be regularly monitored during the treatment (in order to achieve its normalization).

scholarly journals Metabolic encephalopathy caused by nitrous oxide (‘laughing gas’) induced hyperammonaemia

2019 ◽  
Vol 12 (11) ◽  
pp. e232163
Author(s):  
Marissa Ginette Danielle Vive ◽  
Galia Valentinova Anguelova ◽  
Sjoerd Duim ◽  
Herman Marcel André Hofstee
Keyword(s):  
Emergency Department ◽  
Nitrous Oxide ◽  
Altered Mental Status ◽  
Vitamin B ◽  
Recreational Drug ◽  
Metabolic Encephalopathy ◽  
Laughing Gas ◽  
Catabolic State ◽  
Ammonia Degradation

A 26-year-old man presented at the emergency department with confusion and decreased consciousness after several days of vomiting. In the preceding 6 months, he had used a 2-litre tank of nitrous oxide (N2O) weekly. His metabolic encephalopathy was caused by hyperammonaemia which probably resulted from interference of N2O-induced vitamin B12 deficiency with ammonia degradation. A catabolic state might have contributed to the hyperammonaemia in this case. After treatment with vitamin B12 and lactulose, both his consciousness and hyperammonaemia improved. He reported no residual complaints after 3 months of follow-up. Since N2O is increasingly used as a recreational drug, we recommend considering hyperammonaemia as a cause of metabolic encephalopathy in cases of N2O use and altered mental status.

scholarly journals Nitrous oxide myelopathy with functional vitamin B12deficiency

2019 ◽  
Vol 12 (2) ◽  
pp. e227439 ◽  
Author(s):  
John Williamson ◽  
Saif Huda ◽  
Dinesh Damodaran
Keyword(s):  
Nitrous Oxide ◽  
Male Patient ◽  
Neurological Complications ◽  
Vitamin B ◽  
Blood Tests ◽  
Dorsal Columns ◽  
Legal High ◽  
The Uk ◽  
Recreational Use

Recreational use of nitrous oxide as a ‘legal high’ is increasing in the UK. Physicians should be ‘street wise’ to this increasing prevalence and aware of the potential neurological complications which may result from misuse. We describe a 17-year-old male patient who presented to neurology with a severe myelopathy following prolonged recreational use of nitrous oxide. MRI demonstrated characteristic changes affecting the dorsal columns and blood tests demonstrated a ‘functional’ B12 deficiency. Clinical and radiological improvement was noted following initiation of vitamin B12 replacement.

scholarly journals Serum copper decrease and cerebellar atrophy in patients with nitrous oxide-induced subacute combined degeneration: two cases report

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jie Cao ◽  
Lusen Ran ◽  
Chenchen Liu ◽  
Zhijun Li
Keyword(s):  
Nitrous Oxide ◽  
Neuropsychiatric Symptoms ◽  
Neurological Complication ◽  
Macrocytic Anemia ◽  
Cerebellar Atrophy ◽  
Serum Copper ◽  
Copper Level ◽  
Vitamin B ◽  
Subacute Combined Degeneration ◽  
First Time

Abstract Background Subacute combined degeneration (SCD) is a neurological complication commonly associated with vitamin B12 deficiency. It can result from nitrous oxide (N2O) abuse and cause neuropsychiatric symptoms. However, there has been no literature regarding alterations of serum copper and cerebellum in SCD patients. Case presentation We reported two cases of young SCD patients with histories of N2O abuse. In these cases, elevated homocysteine, macrocytic anemia, spinal cord abnormalities, and peripheral nerve injuries were detected. In addition, decreased serum copper level and cerebellar atrophy were reported for the first time. The patients’ symptoms improved after withdrawal of N2O exposure and vitamin B12 supplements. Conclusion We reported two SCD cases with serum copper alteration and cerebellar atrophy after N2O abuse for the first time. These might be crucial complements to the diagnosis of SCD.

Nutritional B12 Deficiency in Infants of Vitamin B12-Deficient Mothers

2011 ◽  
Vol 81 (5) ◽  
pp. 328-334 ◽  
Author(s):  
Oya Halicioglu ◽  
Sezin Asik Akman ◽  
Sumer Sutcuoglu ◽  
Berna Atabay ◽  
Meral Turker ◽  
...  
Keyword(s):  
Megaloblastic Anemia ◽  
Maternal Diet ◽  
Clinical Manifestations ◽  
Serum Vitamin ◽  
Failure To Thrive ◽  
Clinical Findings ◽  
Vitamin B ◽  
Animal Products ◽  
Hematological Evaluation ◽  
Nutritional Vitamin

Aim: Nutritional vitamin B12 deficiency in infants may occur because the maternal diet contains inadequate animal products. Clinical presentations of the infants who had nutritional vitamin B12 deficiency were analyzed in this study. Subjects and Methods: Patients with nutritional vitamin B12 deficiency were enrolled in the study between 2003 and 2010. The diagnosis was based on a nutritional history of mothers and infants, clinical findings, hematological evaluation, and low level of serum vitamin B12. Results: Thirty children aged 1 - 21 months constituted the study group. Poverty was the main cause of inadequate consumption of animal products of the mothers. All infants had predominantly breastfed. The most common symptoms were developmental delay, paleness, apathy, lethargy, anorexia, and failure to thrive. Hematological findings were megaloblastic anemia (83.3 %), thrombocytopenia (30 %), and severe anemia (13.3 %). All of the mothers had low serum B12 levels; eight of them had megaloblastic anemia. Conclusion: The unusual clinical manifestations of vitamin B12 deficiency may also be seen apart from neurological and hematological findings. Nutritional vitamin B12 deficiency due to maternal deficiency might be a serious health problem in infants. Therefore, screening and supplementation of pregnant and lactating women to prevent infantile vitamin B12 deficiency should be considered.

scholarly journals Typical and atypical CT chest imaging findings of novel coronavirus 19 (COVID-19) in correlation with clinical data: impact on the need to ICU admission, ventilation and mortality

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Doaa M. Emara ◽  
Nagy N. Naguib ◽  
M. A. Moustafa ◽  
Salma M. Ali ◽  
Amr Magdi El Abd
Keyword(s):  
Pleural Effusion ◽  
Complete Recovery ◽  
Clinical Findings ◽  
Mediastinal Lymphadenopathy ◽  
Imaging Features ◽  
Imaging Findings ◽  
Icu Admission ◽  
Mortality Outcome ◽  
Novel Coronavirus ◽  
Contrast Ct

Abstract Background The aim of this study was to highlight the typical and atypical chest CT imaging features at first presentation in 120 patients who were proved to be COVID-19 by PCR and to correlate these findings with the need for ICU admission, ventilation, and mortality. We retrospectively included 120 patients 71 males (59.2%) and 49 females (40.8%) with a mean age of 47.2 ± 14.4 years. Patients subjected to clinical assessment, CBC, PCR for COVID-19, and non-contrast CT chest at first presentation. Typical and atypical imaging findings were reported and correlated with the clinical findings of the patients, the need for ICU admission, ventilation, and mortality. Results Clinically, fever was seen in 112 patients followed by dry cough in 108 patients and malaise in 35 patients. The final outcome was complete recovery in 113 cases and death in 7 cases. Typical CT findings included bilateral peripheral ground-glass opacities (GGO) in 74.7%, multilobar affection in 92.5% while atypical findings such as homogeneous consolidation, pleural effusion, mediastinal lymphadenopathy, and single lobar affection were found in 13.4, 5, 6.7, and 7.5% respectively. A statistically significant association between the presence of white lung, pleural effusion, peripheral GGO, and the need for ICU admission as well as mechanical ventilation was noted. The death was significantly higher among elderly patients; however, no significance was found between the imaging features and mortality. Conclusion CT features at first presentation can predict the need for ICU admission and the need for ventilation but cannot predict the mortality outcome of the patients.

A review of contemporary inhalation sedation guidelines and regulations related to treating children

2017 ◽  
Vol 8 (3) ◽  
pp. 112-118 ◽  
Author(s):  
S Rajan ◽  
DJ Manton ◽  
N Bhujel
Keyword(s):  
Nitrous Oxide ◽  
General Anaesthesia ◽  
Paediatric Dentistry ◽  
Safe Practice ◽  
Global Trends ◽  
Inhalation Sedation ◽  
Dental Procedures ◽  
The Us ◽  
The Uk

Inhalation sedation (IS) with nitrous oxide (N2O) is classified as minimal sedation. In paediatric dentistry, IS works well for mildly anxious but potentially cooperative children, reducing the need for general anaesthesia for simple dental procedures. We review contemporary guidelines relating to ISN2O in Australasia, the UK, Europe and the US. As this is a multispecialty area, with differences in laws, regulations, guidance and governance from country to country, this review aims to illuminate global trends and assist with the designing of local regulations for the safe practice of ISN2O.

Nitrous oxide as a diazo transfer reagent: the synthesis of triazolopyridines

2021 ◽  
Author(s):  
Iris R. Landman ◽  
Farzaneh Fadaei-Tirani ◽  
Kay Severin
Keyword(s):  
Nitrous Oxide ◽  
Laughing Gas

Nitrous oxide (N2O, ‘laughing gas’) can be used as diazo transfer reagent for the synthesis of triazolopyridines.

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