Abuse Of Nitrous Oxide Research Articles

Nitrous oxide abuse in a 21-year-old female: a case report and review of literature.

The abuse of nitrous oxide (N2O) poses a substantial public health challenge. In many countries, including China, regulations governing the utilization and accessibility to N2O remain ambiguous, particularly within the food industry. Here, we report a case of a 21-year-old female who presented with symptoms of subacute combined degeneration (SCD) of the spinal cord due to N2O abuse. The patient exhibited bilateral lower limb numbness and weakness, low serum vitamin B12 levels with elevated homocysteine levels, and lumbar spine magnetic resonance imaging (MRI) revealed abnormal signals of the spinal cord. Following cessation of N2O and comprehensive therapy including methylcobalamin and nerve growth factor, the symptoms significantly improved. A follow-up examination 3 months later showed good progress in gait stability. At a 5-year follow-up, the patient's previous clinical symptoms had completely disappeared, and her quality of life had returned to normal. This case underscores the urgency of raising awareness and prevention of N2O abuse, emphasizing the importance of timely diagnosis and comprehensive treatment for patient recovery. Clear formulation and enforcement of relevant regulatory measures are equally crucial in reducing instances of abuse.

Recreational use of nitrous oxide causes seizure, pneumothorax, pneumomediastinum, and pneumopericardium: nitrous oxide and its harm, a case report

Nitrous oxide, commonly known as ‘laughing gas’, has become a popular recreational drug. Whippets, small canisters containing gas in pressurized form, can be easily obtained from a food store. However, inhaling nitrous oxide from these canisters, which contain a 100% concentration, can lead to hypoxia, resulting in seizures or even death. Inhalation of nitrous oxide rarely causes pneumothorax, pneumomediastinum, and pneumopericardium.
 This case study highlights the potential dangers of recreational abuse of nitrous oxide.

Experiences of frostbite injury from recreational use of nitrous oxide canisters in a UK burns center: Not a laughing matter

Nitrous oxide is used as a recreational drug. Contact frostbite injury from compressed gas canisters has previously been described in the literature, but an increased number of such cases has been noted in our busy regional burns center in the UK. A single-center prospective case series of all patients referred and treated for frostbite injury secondary to misuse of nitrous oxide compressed gas canisters between January and December 2022 is presented. Data collection was performed through a referral database and patient case notes. Sixteen patients, of which 7 were male and 9 were female, satisfied the inclusion criteria. Mean patient age was 22.5 years. The median TBSA was 1%. In total, 50% of patients in the cohort had a delayed initial presentation to A&E of greater than 5 days. Eleven patients were reviewed at our burns center for further assessment and management. In total, 11 patients had bilateral inner thigh frostbite injuries, of which 8 had necrotic full-thickness injury, including subcutaneous fat. Seven patients were reviewed at our burns center and offered excision and split-thickness skin graft. Four patients presented with contact frostbite injury to the hand and one patient to the lower lip. This subgroup was managed successfully with conservative management alone. The reproducible pattern of frostbite injury secondary to the abuse of nitrous oxide compressed gas canisters is demonstrated in our case series. The distinct pattern of injury, patient cohort, and anatomical area affected presents an opportunity for targeted public health intervention in this group.

Neurological and Psychological Characteristics of Young Nitrous Oxide Abusers and Its Underlying Causes During the COVID-19 Lockdown.

BackgroundThe COVID-19 pandemic has a serious impact on the mental health of the public due to its economic and social impact. And psychological effects have led to drug and alcohol abuse. After the city lifted the lockdown, we consecutively encountered several young nitrous oxide abusers admitted to hospital for neurological treatment.PurposeTo inform physician decisions and social intervention, this observational study aimed at investigating the neurological and psychological characteristics of nitrous oxide abusers and its underlying causes during the COVID-19 lockdown.MethodsThe nitrous oxide abusers who sought neurological treatment at our hospital between May 2020 and June 2020 were enrolled. Clinical data including socio-demographic, physical examination, laboratory examination, electromyography and neuroimaging were collected. Their motivations for inhaling nitrous oxide, knowledge about the nitrous oxide abuse and the accompanying of family were investigated face to face. Psychological status was assessed by the Symptom Checklist 90 (SCL-90) psychological evaluation.ResultsSix nitrous oxide abusers were enrolled and the age was 22 ± 4.3. Clinical presentations included varying degrees of limb numbness and an ataxic gait. Laboratory examination revealed that all the patients did not have pernicious anemia, 4 patients had decreased vitamin B12 while 3 patients exhibited elevated homocysteine levels. MR of the spinal cord revealed that 4 patients had abnormal signals in the cervical spinal cord of high symmetry with splayed or inverted V sign after T2WI. Electromyogram (EMG) test showed 5 patients had peripheral nerve damage. The SCL-90 psychological evaluation results indicated that all patients had severe anxiety, depression and psychosis and they had severer psychological problems than ordinary citizens. Their motives for inhaling nitrous oxide are to relieve boredom, curiosity and buddy pressure. Their family spent <1 day per week to stay with them during city lockdown.ConclusionThe enrolled patients caused by abuse of nitrous oxide presented with symptoms of subacute combined with spinal degeneration. They had more serious psychological problems related to the COVID-19 pandemic. These cases make us value the psychological problems of young people under the outbreak and take multi-layered measures from families, schools (companies), hospitals, and governments to address it.

The Clinical Presentations of Nitrous Oxide Users in an Emergency Department.

Today, the concomitant abuse of nitrous oxide (N2O) and illicit drugs is evident and problematic. However, there are few reports regarding the clinical manifestations of N2O users when they present to the emergency department (ED). The purpose of this study was to describe the clinical presentations, the associated illicit substances used in combination, and the outcomes in N2O users visiting the ED. This was a retrospective observational cohort study. All N2O adult users admitted to the ED at Linkou Chang Gung Memorial Hospital between 2012 and 2020 were included. Demographic variables, clinical symptoms, and examination results were collected from medical records. Univariate comparisons were conducted between pure N2O users and combined illicit drug users. A total of 40 patients were included, 24 of which were pure N2O users. Limb weakness and numbness accounted for the majority of chief complaints. Neurologic symptoms were the most common clinical manifestations (90%). A more severe ED triage level, faster heart rate, greater agitation, and cardiovascular symptoms were significantly noted in combined illicit drug users. In ED, limb numbness/weakness should arouse physicians’ awareness of patients using N2O. Combined use of N2O and illicit drugs can cause great harm to health.

Psychiatric manifestations of laughing gas

Nitrous oxide, also known as laughing gas, is a compound which has long been used as an anesthetic. Due to its euphoric effect and legal status, its recreational use has become probably more and more common and could be considered a compound that presents a risk of abuse. Abuse of nitrous oxide can lead to well-known neurological manifestations but also to psychiatric symptoms that often remain unrecognized. These symptoms will be described in this article.

Elucidating Unique Axonal Dysfunction Between Nitrous Oxide Abuse and Vitamin B12 Deficiency.

Introduction: Abuse of nitrous oxide (N2O) has an unusually high lifetime prevalence in developed countries and represents a serious concern worldwide. Myeloneuropathy following the inhalant abuse is commonly attributed to the disturbance of vitamin B12 metabolism, with severe motor deficits are often noted. The present study aims to elucidate its underlying pathophysiology.Methods: Eighteen patients with N2O abuse or vitamin B12 deficiency were recruited. Comprehensive central and peripheral neuro-diagnostic tests were performed, including whole spine MRI, and thermal quantitative sensory testing (QST). Specifically, paired motor and sensory nerve excitability tests were performed in order to obtain a complete picture of the sensorimotor axonal damage.Results: The mean duration of N2O exposure for the N2O abuse patients was 17.13 ± 7.23 months. MRI revealed T2 hyperintensity in 87.5% of the N2O abuse patients and 50% of the vitamin B12 deficiency patients. In N2O abuse patients, the motor nerve excitability test showed decreased in peak response (7.08 ± 0.87 mV, P = 0.05), increased latency (7.09 ± 0.28 ms, P < 0.01), increased superexcitability (−32.95 ± 1.74%, P < 0.05), and decreased accommodation to depolarizing current [TEd (40–60 ms) 56.53 ± 0.70%, P < 0.05]; the sensory test showed only decreased peak response (30.54 ± 5.98 μV, P < 0.05). Meanwhile, motor test in vitamin B12 deficiency patients showed only decreased accommodation to depolarizing current [TEd (40–60 ms) 55.72 ± 1.60%, P < 0.01]; the sensory test showed decreased peak response (25.86 ± 3.44 μV, P < 0.05) increased superexcitability (−28.58 ± 3.71%, P < 0.001), increased subexcitability (8.31 ± 1.64%, P < 0.05), and decreased accommodation to depolarizing current [TEd (peak) 67.31 ± 3.35%, P < 0.001].Conclusion: Compared to vitamin B12 deficiency, N2O abuse patients showed prominent motor superexcitability changes and less prominent sensory superexcitability changes, hinting a unique pathological process different from that of vitamin B12 deficiency. N2O abuse might cause axonal dysfunction not only by blocking methionine metabolism but also by toxicity affecting the paranodal region.

Abuse of nitrous oxide on ‘diverse’ college agenda

Abuse of nitrous oxide on ‘diverse’ college agenda

Imaging appearance of myelopathy secondary to nitrous oxide abuse: a case report and review of the literature

Purpose The abuse of nitrous oxide (N2O) can induce Vitamin B12 deficiency that subsequently leads to central nervous demyelination, myelopathy and peripheral neuropathy. Although myelopathy has been reported in the past, the specific locations and prognosis of the disease are still unclear.Materials and methods: We report the case of a 22-year-old male who presented with quadriplegia that began after a 3-month history of inhalation of N2O. We summarized the clinical data of this entity and performed a comprehensive literature review of various presentations and MRI features of myelopathy secondary to N2O abuse.Results: In combination with previous reports of 14 cases, we found that the onset of the disease was usually subacute, and the majority of patients (92.85%) were young men. There was no definite relationship between myelopathy and the amount or duration of N2O inhalation. The most common clinical manifestation was sensory ataxia, and the cervical spinal cord was the most frequently impaired area of the whole spinal cord. The spinal cord lesions had a high signal intensity on T2-weighted MRI and usually involved more than three spinal segments and impaired the posterior column more significantly. Most patients recovered well after vitamin B12 supplementation.Conclusions: Myelopathy secondary to N2O abuse is generally seen in young men. The clinical diagnosis mainly depends on a history of N2O inhalation and the characteristic imaging changes in the posterior cervical spinal cord. Early diagnosis and intervention are important for a satisfactory prognosis.

T26. Clinical, neurophysiological features of neuropathies induced by abuse of nitrous oxide

Introduction Nitrous Oxide (N2O) is a kind of oxidant, which has been used as an inhalation anesthetic agent for pain and surgery. It is usually inhaled from a balloon and it’s known to precipitate vitamin B12 deficiency and may cause neurologic, hematologic and reproductive disorders. Methods Two cases with neuropathies induced by abuse of N2O admitted to our hospital were studied. The clinical and neurophysiological data were analyzed. Results Case 1: A 21 years old male patient developed lower limb weakness and numbness in both feet with walking unsteadily, following twice a week inhalation of N2O for one month. Neurological examination demonstrated both lower extremities weakness, left more than right, distal more than proximal. Sensory disturbances were found at below the ankles. Ankle reflexes were absent on both sides. Blood routine was normal; folic acid: 7.07 ng/ml, Vitamin B12: 116 pg/ml; CSF analysis and Immune tests were normal, MRI of lumbar and thoracic was normal. EMG showed denervation potentials in both TA and MG muscles; NCS showed the amplitudes of CMAPs of peroneal and tibial nerves were reduced, but MCV and distal latencies were normal. SCS and F waves were within normal ranges. H reflexes were absent bilaterally. He was treated with mecobalamin for 2 weeks and fully recovered. Case 2: A 17 years old female patient developed weakness and paresthesias in both legs and numbness in both hands following intermittent inhalation of N2O for 6 months. On examinations the muscle strength of ankle dorsal and planter flexions were 1/5, knee flexions and extensions were 4/5 pin prick sensation was reduced at below knees. Knee and ankle reflexes were absent bilaterally. Blood routine was normal. Vitamin B12 was at subnormal lever. CSF analysis and GM1 and GQ1b tests were normal. NCS showed absent of CMAP of both peroneal and tibial nerves. F waves were absent and sensory nerve conduction studies were normal. H reflexes were absent bilaterally. She was also treated with mecobalamin for one month with substantial clinical improvement. Conclusion The distinctive clinical and neurophysiology pattern of N2O induced neuropathies demonstrate an acute, motor severer than sensory, length dependent, axonal polyneuropathy. Its severity is related to the amount of N2O abused. The patients improved substantially after vitamin B12 supplement when the patients abstained from further nitrous oxide abuse.

Funicular myelosis in a butcher: it was the cream cans.

Background. Funicular myelosis is a known consequence of exposure to nitrous oxide. Nevertheless, there are only a few clinical trials assessing its long-term effects and there is no literature about the role of nutritional vitamin B12 supplementation in the context of nitrous oxide abuse. Case Descriptions. We diagnosed funicular myelosis in a young butcher, who consumed high amounts of meat regularly. Since the diagnostic process did not reveal any metabolic causes, reinterrogation of the patient uncovered recreational abuse of nitrous oxide out of whipped cream can gas cartridges. After stopping abuse and supplementation of vitamin B12, the patient recovered almost completely. Conclusions. In our case, even high nutritional vitamin B12 uptake could not compensate the noxious effects of nitrous oxide. Since there are emerging reports of increasing misuse, this should be considered in the diagnostic and therapeutic care of patients with nitrous oxide abuse. Furthermore, our case emphasizes that patients with vitamin B12 deficiency should be assessed for nitrous oxide abuse.

Use and abuse of nitrous oxide in dentistry

N oxide is a colorless and virtually odorless gas with a faint, sweet smell. It is a safe and effective tool used in dental clinics to reduce anxiety, produce analgesia, and cause the depression of the central nervous system (CNS), leading to the sensation of euphoria with little effect on the respiratory system. It also enhances effective communication between the patient and their healthcare provider. The decision to use nitrous oxide/oxygen must take into consideration the alternative behavioral guidance modalities, the patient’s dental needs, the effect on the quality of dental care, the patient’s emotional development, and the patient’s physical considerations.

A case of unusual substance abuse causing myeloneuropathy

Case report. Examine an unusual drug related case of myeloneuropathy as well as the pathophysiology of nitrous oxide induced subacute combined degeneration. Major metropolitan teaching hospital - Princess Alexandra Hospital, Queensland, Australia. Review case notes, investigations, relevant medical literature and epidemiological data. A 23-year-old female developed a myeloneuropathy and encephalopathy after an 8-month history of nitrous oxide abuse. Her presentation was complicated by acute renal failure, deep vein thrombosis (DVT) and pulmonary embolism (PE) as well as severe cognitive deficits. After eight months of multidisciplinary rehabilitation the patient is able to walk short distances with mobility aids and is able to manage self cares. However, she still requires a wheelchair for long distances and will have significant residual neurological deficits. The abuse of nitrous oxide has potentially serious outcomes that require discussion of issues related to harm minimisation and health promotion.

Abuse of Nitrous Oxide

Abuse of Nitrous Oxide

Reversible myeloneuropathy of nitrous oxide abuse: Serial electrophysiological studies

Detailed electrophysiological studies were performed in 4 patients with myeloneuropathy induced by abuse of nitrous oxide for 1 to 4 years. All presented with paresthesias, weakness, and Lhermitte's phenomena, and exhibited signs of sensorimotor polyneuropathy, ataxia, and arreflexia. Two had subnormal serum vitamin B12 levels. Baseline electrophysiologic testing revealed reduced motor unit potentials, prolonged F wave latencies, absent H reflexes, denervation potentials, and delays in motor and sensory conduction. Three had peripheral and nuchal delay after median nerve stimulation. All were reevaluated after 3 to 12 months' abstinence and treatment with vitamin B12, and all showed substantial clinical improvement. Parallel improvement in electrophysiologic findings occurred, but residual minor conduction delays, loss of H reflexes, electromyographic evidence of denervation, or abnormalities of posterior tibial SEP were noted. These findings confirm the reversibility of myeloneuropathy of nitrous oxide abuse and describe the profile of electrophysiologic recovery in subjects who abstain from further neurotoxic exposure.

Abuse of nitrous oxide: Rosenberg H, Orkin FK, Springstead J, Anesth Analg48:104–106 (Mar/Apr) 1979

Abuse of nitrous oxide: Rosenberg H, Orkin FK, Springstead J, Anesth Analg48:104–106 (Mar/Apr) 1979

Neuropathy following Abuse of Nitrous Oxide

A disabling peripheral neuropathy, mainly sensory, developed in three health workers who habitually abused nitrous oxide. The distinctive clinical picture included patterns of numbness that were radicular rather than purely distal, and a reverse Lhermitte sign, in the absence of signs of spinal cord involvement. Nerve conduction studies suggested an axonal rather than demyelinative neuropathy. The neurologic disorder improved slowly when the patients abstained from further nitrous oxide abuse.

Abuse of Nitrous Oxide

The results of an anonymous questionnaire showed that up to 20% of medical and dental students have utilized nitrous oxide in a social setting to produce a "high." Nitrous oxide was obtained from a variety of sources, most often from cylinders used in the production of whipped cream. Although none of the 524 respondents described personal injury with the use of nitrous oxide, a few individuals reported cyanosis, nausea, and syncope.

Neuropathy following abuse of nitrous oxide

A disabling peripheral neuropathy, mainly sensory, developed in three health workers who habitually abused nitrous oxide. The distinctive clinical picture included patterns of numbness that were radicular rather than purely distal, and a "reverse" Lhermitte sign, in the absence of signs of spinal cord involvement. Nerve conduction studies suggested an axonal rather than demyelinative neuropathy. The neurologic disorder improved slowly when the patients abstained from further nitrous oxide abuse.

Four Deaths Resulting from Abuse of Nitrous Oxide

Abstract Nitrous oxide is a weak anesthetic gas, used alone for dental work and as an adjunct to more potent anesthetics in major surgical procedures. It is the only inorganic gas that is practical for clinical anesthesia. Like all the anesthetic drugs, nitrous oxide has been subject to abuse. Unlike the other anesthetic agents, where the abuse is almost exclusively by medical personnel, nitrous oxide has been abused by the general public.