Recreational nitrous oxide abuse causing B12 deficiency with subacute combined degeneration of the spinal cord: A case report

Razaq, Jazeb; Qureshi, Saffan

doi:10.4103/jfmpc.jfmpc_1630_20

Cited by 3 publications

(2 citation statements)

References 6 publications

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“…Moreover, severe complications such as thrombotic sequelae usually occur, associated with neurological, hematological, and psychiatric signs and symptoms of chronic N 2 O abuse [1,2,4,5,12,13,20,28,29]. On the other hand, the prompt discontinuation of N 2 O and the supplementation of vitamin B12 rapidly improve the clinical features of the patients, potentially leading to the extensive resolution of signs and symptoms in the large majority of reported cases [1][2][3]14,[30][31][32][33].…”

Section: Introductionmentioning

confidence: 99%

Nitrous Oxide Inhalant Abuse: Preliminary Results from a Cross-Sectional Study on Knowledge, Attitudes, and Practices of Italian Physicians (2023)

Riccò,

Ferraro,

Corrado

et al. 2023

Medicina

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Background and Objectives: Nitrous oxide (N2O) has recently emerged as a cheap alternative to other recreational substances. Although legally available, its chronic use is associated with severe neurological and hematological complications due to the irreversible inactivation of vitamin B12. While no reliable data on abuse of N2O in Italy have been provided to date, we assessed the knowledge, attitudes, and practices of Italian medical professionals on the management of N2O abuse cases. Materials and Methods: A cross-sectional study was performed as a web-based survey through a series of Facebook discussion groups (targeted medical professionals: 12,103), and participants were specifically asked about their previous understanding of N2O abuse and whether they had or not any previous experience in this topic. Results: A total 396 medical professionals participated in the survey. Overall, 115 participants had previous knowledge about N2O abuse (29.04%), with higher odds for professionals with a background in emergency medicine (adjusted odds ratio (aOR) 3.075; 95% confidence intervals (95%CI) 1.071 to 8.828) and lower for specialists in psychiatry (aOR 0.328; 95%CI 0.130 to 0.825). Knowledge status on N2O abuse was largely unsatisfying, as knowledge status, reported as a percent value, was estimated to 45.33% ± 24.71. Having previously managed a case of N2O abuse was associated with higher risk perception of the actual severity of this condition (aOR 5.070; 95%CI 1.520 to 16.980). Conclusions: Our study suggests that N2O poisoning cases are occurring in Italian settings but are not reasonably reported to national authorities. As substantial knowledge gaps of Italian medical workforces were identified, we cannot rule out that the actual abuse of N2O in the population may be far larger than currently suspected.

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Section: Introductionmentioning

confidence: 99%

Nitrous Oxide Inhalant Abuse: Preliminary Results from a Cross-Sectional Study on Knowledge, Attitudes, and Practices of Italian Physicians (2023)

Riccò,

Ferraro,

Corrado

et al. 2023

Medicina

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“…Moroccans) was also recently reported (Nabben et al, 2021). Excessive N 2 O use may lead to vitamin B 12 deficiency (Lan et al, 2019; Razaq and Qureshi, 2020; Winstock and Ferris, 2020), which can cause neurological damage with sometimes irreversible sequelae if diagnosis and treatment are delayed (Bethmont et al, 2019; Garakani et al, 2016; Nutt et al, 2020; Oussalah et al, 2019; Xiang et al, 2021; Zheng et al, 2020). More specifically, the spinal cord is an important injury site associated with problematic N 2 O use, and – considering the growing number of published case reports – paraplegia following frequent N 2 O use is no longer uncommon.…”

Section: Introductionmentioning

confidence: 99%

Increasing recreational nitrous oxide use: Should we worry? A narrative review

2022

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Background: Since 2000, the prevalence of recreational nitrous oxide (N2O) use has increased in the Western world. Although N2O is a relatively safe drug, the overall increase in the use of N2O has concomitantly also initiated a modest but important increase in the number of young excessive users. The recent introduction of large 2 kg N2O tanks, allowing high and prolonged dosing, has facilitated this excessive use. This is of concern, because repeated exposure to high doses of N2O for a prolonged time is known to induce neurological damage, such as (irreversible) neuropathy and paralysis due to N2O-induced vitamin B12 deficiency. The increasing trend of recreational users with N2O-induced neurological damage at emergency departments confirms the urgency of this development. Objective/Methods: This narrative review describes recent trends in N2O use and misuse, the adverse health effects associated with excessive use and the risk factors of excessive use. Results: Considering the rising trend in N2O use, particularly among young and other vulnerable people, we propose to take legislative action to limit the availability of N2O, and also advocate for better and timely education of non-users, users and medical professionals about the serious side-effects associated with excessive N2O use. Conclusion: It is concluded that the increase in excessive N2O use is of serious concern.

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2024

InnovAiT: Education and inspiration for general practice

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Recreational nitrous oxide abuse causing B12 deficiency with subacute combined degeneration of the spinal cord: A case report

Cited by 3 publications

References 6 publications

Nitrous Oxide Inhalant Abuse: Preliminary Results from a Cross-Sectional Study on Knowledge, Attitudes, and Practices of Italian Physicians (2023)

Nitrous Oxide Inhalant Abuse: Preliminary Results from a Cross-Sectional Study on Knowledge, Attitudes, and Practices of Italian Physicians (2023)

Increasing recreational nitrous oxide use: Should we worry? A narrative review

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