Nitrous oxide toxicity: Difference between revisions
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==Background== | ==Background== | ||
*Nitrous oxide toxicity is often associated with inhalation of whipped cream or small nitrous oxide cannisters ([[whippets]]) | *Nitrous oxide toxicity is often associated with inhalation of whipped cream or small nitrous oxide cannisters ([[whippets]]) | ||
*Nitrous is much more soluble in blood and will quickly diffuse from the blood to a closed space | *Commonly abused drug notable for its short-lived euphoric and calming effects through noncompetitive NMDA antagonism and GABA-A agonism. | ||
*Beyond the gaseous effects nitrous oxide mainly disrupts B12 by oxidizing the | *Nitrous is much more soluble in blood and will quickly diffuse from the blood to a closed space. | ||
*Beyond the gaseous effects nitrous oxide mainly disrupts B12 by oxidizing the cobalt ion which irreversibly inhibits methionine synthase<ref>Nunn J. Clinical aspects of the interaction between nitrous oxide and vitamin B12. British Journal of Anaesthesia. 1987; 59:3-13</ref> | |||
*Epidemiology | |||
**Rates of nitrous oxide misuse vary significantly by country and are generally higher in Europe and the United States. | |||
**The World Drug Report found nitrous oxide use (i.e. at least once in last 12 months) in 16-24 year olds doubled globally between 2015 to 2021, from 10% to 20%.<ref>United Nations Office on Drugs and Crime. World Drug Report 2021. 2021. [https://www.unodc.org/unodc/en/data-and-analysis/wdr2021.html]</ref> | |||
*Most nitrous oxide misuse is sporadic and without significant health consequences. This and its ease of availability may lead users to erroneously view it as safe. | |||
==Clinical Features== | ==Clinical Features== | ||
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*Tracheal trauma | *Tracheal trauma | ||
*[[Air emboli]] | *[[Air emboli]] | ||
*Thrombotic events (rare, typically in | *Thrombotic events (rare, typically in subacute toxicity from homocysteine elevation) | ||
**[[Venous thromboembolism]] | **[[Venous thromboembolism]] | ||
**[[Acute arterial ischemia]] | **[[Acute arterial ischemia]] | ||
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**[[Megaloblastic anemia]] | **[[Megaloblastic anemia]] | ||
**[[Thrombocytopenia]] | **[[Thrombocytopenia]] | ||
*Peripheral neuropathy | |||
*Subacute combined degeneration of the spinal cord | |||
==Evaluation== | ==Evaluation== | ||
*Nitrous oxide use is undetectable by standard drug screens, which makes obtaining a thorough history crucial.<ref>Agarwal P, et al. Recreational nitrous oxide-induced subacute combined degeneration of the spinal cord. Cureus. 2021;13(11):e19377. [https://pmc.ncbi.nlm.nih.gov/articles/PMC8653952/]</ref> | |||
*Neuro deficits: | |||
**Consult poison control for recommendations. | |||
**May be exacerbated in cases of underlying [[B12 deficiency]]. | |||
===Workup=== | ===Workup=== | ||
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==See Also== | ==See Also== | ||
*[[Nitrous oxide]] | *[[Nitrous oxide]] | ||
*[[Vitamin B12 deficiency]] | |||
==External Links== | ==External Links== | ||
Latest revision as of 04:22, 16 August 2025
Background
- Nitrous oxide toxicity is often associated with inhalation of whipped cream or small nitrous oxide cannisters (whippets)
- Commonly abused drug notable for its short-lived euphoric and calming effects through noncompetitive NMDA antagonism and GABA-A agonism.
- Nitrous is much more soluble in blood and will quickly diffuse from the blood to a closed space.
- Beyond the gaseous effects nitrous oxide mainly disrupts B12 by oxidizing the cobalt ion which irreversibly inhibits methionine synthase[1]
- Epidemiology
- Rates of nitrous oxide misuse vary significantly by country and are generally higher in Europe and the United States.
- The World Drug Report found nitrous oxide use (i.e. at least once in last 12 months) in 16-24 year olds doubled globally between 2015 to 2021, from 10% to 20%.[2]
- Most nitrous oxide misuse is sporadic and without significant health consequences. This and its ease of availability may lead users to erroneously view it as safe.
Clinical Features
Differential Diagnosis
Acute complications
- Pneumothorax (induced by forceful inhalation or high-pressure tank siphoning)
- Tympanic membrane rupture
- Tracheal trauma
- Air emboli
- Thrombotic events (rare, typically in subacute toxicity from homocysteine elevation)
Chronic complications
- Bone marrow suppression (from long term exposure)
- Peripheral neuropathy
- Subacute combined degeneration of the spinal cord
Evaluation
- Nitrous oxide use is undetectable by standard drug screens, which makes obtaining a thorough history crucial.[3]
- Neuro deficits:
- Consult poison control for recommendations.
- May be exacerbated in cases of underlying B12 deficiency.
Workup
Diagnosis
Management
Disposition
See Also
External Links
References
- ↑ Nunn J. Clinical aspects of the interaction between nitrous oxide and vitamin B12. British Journal of Anaesthesia. 1987; 59:3-13
- ↑ United Nations Office on Drugs and Crime. World Drug Report 2021. 2021. [1]
- ↑ Agarwal P, et al. Recreational nitrous oxide-induced subacute combined degeneration of the spinal cord. Cureus. 2021;13(11):e19377. [2]