The Clinical Presentations of Nitrous Oxide Users in an Emergency Department

Abstract

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.

High Incidence of Signs of Neuropathy and Self-Reported Substance Use Disorder for Nitrous Oxide in Patients Intoxicated with Nitrous Oxide

“…Selling and buying N 2 O tanks was legal in The Netherlands until recently but will be banned from January 1, 2023 [30]. Notably, we observed that the majority of patients with N 2 O intoxication used solely N 2 O, without concomitant drug or alcohol exposures, which has also been observed in other studies [1, 28, 31]. This is remarkable because most recreational drug intoxications reported to the DPIC concern poly-drug intoxications [32].…”

Mechanisms Involved in the Neurotoxicity and Abuse Liability of Nitrous Oxide: A Narrative Review

“…This is of serious concern because repeated exposure to high doses of N 2 O for a prolonged time is known to induce neurological damage, such as (irreversible) neuropathy and paralysis due to N 2 O-induced cobalamin deficiency [ 15 , 16 , 17 , 18 , 19 ]. The increasing trend of recreational users with N 2 O-induced neurological damage at emergency departments confirms the urgency of this development [ 9 , 20 , 21 ].…”

Mechanisms and recent advances in the diagnosis and treatment of nitrous oxide-induced peripheral neuropathy: a narrative review

“…Therefore, it is imperative to understand and address the potential risks associated with prolonged inhalation of N₂O (3,4). Additionally, the increasing incidence of individuals presenting at emergency departments with neurological impairments due to N₂O exposure highlights the concerning and serious nature of this trend (5).…”