Nitrous Oxide Abuse Associated with Severe Thromboembolic Complications

Vollenbrock, Sophie E; Fokkema, Talje M.; Leijdekkers, V.J.; Vahl, A.C.; Konings, Renske; Nieuwenhuizen, R.C. van

doi:10.1016/j.ejvs.2021.05.041

Cited by 14 publications

(7 citation statements)

References 5 publications

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“…However, chronic N 2 O consumption has dramatically increased in Europe [ 1 ], and it can lead to neurological symptoms which can be sensory disorders such as paresthesia or motor disorders such as walking disorders [ 2 ]. Although the neurological symptoms can be more severe with the development of a disabling motor handicap or combined subacute degeneration of the spinal cord, psychological disorders and thrombotic events have been reported [ 1 , 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

Plasma Methionine and Clinical Severity in Nitrous Oxide Consumption

Gernez¹,

Deheul²,

Tard³

et al. 2022

Toxics

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In the last few years, there has been an increase in the recreational use of nitrous oxide (N2O), which can lead to neurological symptoms such as sensory or motor disorders. The literature links these symptoms to a functional inactivation of vitamin B12 by oxidation of its cobalt ion, which prevents the vitamin B12 from acting as a cofactor for methionine synthase. Thus, demyelination related to methionine deficiency could be responsible for the neurological disorders associated with N2O consumption, including the combined sclerosis of the spinal cord. We aimed to study the correlation between the plasma methionine levels and clinical severity observed in N2O users. We retrospectively collected clinical and biological data from 93 patients who chronically consumed N2O. The patients were divided into four groups based of the severity of their clinical symptoms (based on their Peripheral Neuropathy Disability (PND) score). The plasma amino acids measurement, including methionine, were performed systematically by liquid chromatography coupled with mass spectrometry. Plasma methionine is significantly correlated with the clinical severity (Spearman coefficient: −0.42; p-value < 10−5), however, the average methionine level in the four groups is within the physiological values (N: 16–23 µmol/L). There is a significant inverse correlation between plasma methionine and homocysteine (Spearman coefficient: −0.57; p-value < 10−9), which confirms the action of nitrous oxide on the methionine synthase. A decrease in plasma methionine cannot be imputed as the only mechanism involved in the pathophysiology of the neurological disorders in nitrous oxide consumption. In addition, there are few therapeutic indications for the use of methionine. Thus, we should be careful concerning the potential use of methionine in nitrous oxide consumption. As a consequence, other pathophysiological mechanisms probably need to be identified in order to find potential therapeutic targets.

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Section: Introductionmentioning

confidence: 99%

Plasma Methionine and Clinical Severity in Nitrous Oxide Consumption

Gernez¹,

Deheul²,

Tard³

et al. 2022

Toxics

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“…High levels of homocysteine are associated with dysfunction of the endothelium, oxidative stress, increased platelet activation, higher production of thrombin, enhanced activity of factor V, impaired fibrinolysis, and inflammation of the blood vessels leading to early development of atherosclerosis, arteriosclerosis, and thromboembolism (25). Elevated homocysteine levels are showed to be associated with arterial thrombus formation, peripheral arterial disease, ischemic disease and myocardial infarction, stroke, pulmonary embolism, and thrombus formation in the abdominal veins (13,(24)(25)(26)(27)(28)(29).…”

Section: Discussionmentioning

confidence: 99%

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

Davidson

2023

ujms

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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.

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“…Long-term exposure to N 2 O can lead to many psychiatric symptoms, such as delusions, delirium, and depression. Apart from psychiatric symptoms, it also causes B 12 deficiency, leading to peripheral neuropathy and megaloblastic anemia [ 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ].…”

Section: The Current Situation Of Non-opioid Anesthetics Addictionmentioning

confidence: 99%

Non-Opioid Anesthetics Addiction: A Review of Current Situation and Mechanism

Deng,

Wu,

Gao

et al. 2023

Brain Sciences

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Drug addiction is one of the major worldwide health problems, which will have serious adverse consequences on human health and significantly burden the social economy and public health. Drug abuse is more common in anesthesiologists than in the general population because of their easier access to controlled substances. Although opioids have been generally considered the most commonly abused drugs among anesthesiologists and nurse anesthetists, the abuse of non-opioid anesthetics has been increasingly severe in recent years. The purpose of this review is to provide an overview of the clinical situation and potential molecular mechanisms of non-opioid anesthetics addiction. This review incorporates the clinical and biomolecular evidence supporting the abuse potential of non-opioid anesthetics and the foreseeable mechanism causing the non-opioid anesthetics addiction phenotypes, promoting a better understanding of its pathogenesis and helping to find effective preventive and curative strategies.

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Nitrous Oxide Abuse Associated with Severe Thromboembolic Complications

Cited by 14 publications

References 5 publications

Plasma Methionine and Clinical Severity in Nitrous Oxide Consumption

Plasma Methionine and Clinical Severity in Nitrous Oxide Consumption

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

Non-Opioid Anesthetics Addiction: A Review of Current Situation and Mechanism

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