NITROUS OXIDE USE DISORDER IN ADOLESCENTS: THE SERIOUS SIDE EFFECTS OF “WHIPPITS”

Abstract

A 17-year-old male with a history of attention-deficit/hyperactivity disorder (ADHD) was brought by the police to the emergency room from his school for bizarre behavior. According to the reports, the patient had been observed talking to himself during class, laughing inappropriately, and making odd statements. The patient initially denied illicit substance use, and his urine toxicology and volatile screens were negative. His physical exam was notable for diffuse hyperreflexia and decreased sensation to light touch of his hands and feet. Additional laboratory data was requested and included a normal B12 level, mildly elevated methylmalonic acid, and significantly elevated homocysteine. On further questioning, the patient endorsed recent frequent inhalation of nitrous oxide, which he minimized, pointing out that nitrous oxide “is just laughing gas.”