1
|
Mohammed H, Sara E, Bouchra O. Acute psychotic and vitamin B12 deficiency in patient with nitrous oxide misuse: A case report. SAGE Open Med Case Rep 2024; 12:2050313X241269577. [PMID: 39131582 PMCID: PMC11311192 DOI: 10.1177/2050313x241269577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 06/25/2024] [Indexed: 08/13/2024] Open
Abstract
Nitrous oxide, also called nitrous monoxide, or nitrous oxide, is a colorless and odorless gas, without toxicological effect, but it can be asphyxiating at high concentration, its misuse is increasing especially among young people. Chronic use of N2O may cause psychiatric complications, including depression, hypomania, and paranoid psychosis with visual and auditory hallucinations. We present a case of nitrous oxide abuse "laughing gas" in 25 years old woman with bizarre behavior delusions and hallucinations with a normal neurological examination. The patient had low levels of vitamin B12 (135 pmol/L). Treatment with antipsychotics and vitamin B12 (cobalamin) resolved her psychosis. In addition to the hematological and neurological effects, rare cases of acute psychosis, especially in young people with or without psychiatric history, use varies from 1 month to years. Clinicians are increasingly in need of knowledge regarding the misuse of nitrous oxide.
Collapse
Affiliation(s)
- Hasnaoui Mohammed
- Department of Psychiatry, University Hospital of Mohammed VI-Oujda, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Echater Sara
- Department of Psychiatry, University Hospital of Mohammed VI-Oujda, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
- Psychiatry Department, Faculty of Medicine and Pharmacy of Tangier, Université Abdelmalek Essaadi, CHU Mohammed VI, Tangier, Morocco
| | - Oneib Bouchra
- Department of Psychiatry, University Hospital of Mohammed VI-Oujda, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| |
Collapse
|
2
|
Raaj S, Ahmed MS, Warren E, Farrelly R. An Episode of Psychosis After Nitrous Oxide Abuse During a Pandemic: A Case Report. Cureus 2024; 16:e60634. [PMID: 38903353 PMCID: PMC11187452 DOI: 10.7759/cureus.60634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2024] [Indexed: 06/22/2024] Open
Abstract
The abuse of inhalants like nitrous oxide (N2O), readily available worldwide, has remained a prominent public health problem during the last few decades. Literature reveals increased use during the previous pandemic, particularly regarding recreational use. There is limited evidence-based data available to relate the abuse of N2O with psychosis. Therefore, this case report of a 22-year-old adult with no previous psychiatry history, reportedly abusing 75-100 canisters of N2O per day during the last pandemic COVID-19 lockdown, highlights the relationship between (N2O) abuse and the symptoms evolved including delusions, auditory hallucinations, and disorganized cognition. All the laboratory findings and results from imaging modalities were inconsistent for any organic cause of the symptoms. The case then underwent treatment with antipsychotic medications and a multidisciplinary model, which improved the symptoms gradually. The case, in particular, discusses N2O abuse, which is widespread in European Union countries, including the UK and the Republic of Ireland, and its chronic use puts one at a higher risk of developing psychosis, personality changes, affective lability, anxiety, depression, cognitive impairment, and myeloneuropathy. The sale of N2O for its psychoactive properties is prohibited in many countries, including the Republic of Ireland, as per legislation. However, N2O is not a controlled drug, meaning it is not a crime to possess N2O. This case report manifests the psychopathy caused by abuse of N2O, which would further attract specialists in the field to conduct epidemiological studies for prevention at the primary level.
Collapse
Affiliation(s)
- Shaeraine Raaj
- Psychiatry, Connolly Hospital Blanchardstown, Dublin, IRL
- Psychiatry, Phoenix Care Centre, Dublin, IRL
| | | | - Emma Warren
- Medicine, Trinity College Dublin, Dublin, IRL
| | | |
Collapse
|
3
|
Luigi C, Stefania DS. Nitrous oxide intoxication: systematic literature review and proposal of new diagnostic possibilities. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2022. [DOI: 10.1186/s41935-022-00315-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Abstract
Background
Nitrous oxide (N2O), also called “laughing gas,” is the most commonly used inhalation anesthetic in dentistry. The N2O is no longer used, because of the long-term neurologic and cardiovascular sequelae. Due to its sedative and euphoric properties, N2O is often used for recreational use or in some erotic activities. Accidental deaths are mainly associated with the uses of N2O: death can occur from sudden cardiac arrhythmia or, most commonly, acute asphyxiation due to hypoxia. This paper aims to study the literature concerning deaths due to N2O intoxication and highlight pathological findings useful for diagnosis when the crime scene investigation does not reveal any evidence.
Materials and methods
The authors conducted the literature search by PubMed and Scopus databases, searching for articles from 1 January 1970 to 1 March 2020 using the key terms: “Nitrous oxide,” “Laughing gas,” “Hypoxic damage,” “Nitrous oxide anesthesia,” and “Nitrous oxide death.”
Results and discussion
A total of 244 articles were collected. Only 26 articles were included in the systematic review. Most of the deaths from intoxication are due to asphyxiation; the diagnosis is often difficult and immunohistochemistry could be helpful. Nitrous oxide increases the intracellular adhesion molecule expression, E- and P-Selectin (markers of the early inflammatory response), and HIF-1 α (indicative of oxidative stress during ischemia-reperfusion).
Conclusion
The macroscopic and microscopic signs of N2O intoxication are non-specific, but N2O has been proven to cause hypoxic damage to the brain. The suspicion of the presence of the gas in the environment should guide the pathologist. Tissue analyzes provide important information; immunohistochemical stains can confirm hypoxic damage through the use of markers such as HIF-1 α, E-Selectin, and P-Selectin.
Collapse
|
4
|
de Carvalho J, Lerner A, Feingold D. Management of Hyperhomocysteinemia, Low Vitamin Levels, and Low Cortisol in Cannabis Users: A Report of 2 Cases. J Chiropr Med 2022; 21:322-326. [DOI: 10.1016/j.jcm.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 03/05/2022] [Accepted: 03/06/2022] [Indexed: 10/17/2022] Open
|
5
|
The Clinical Presentations of Nitrous Oxide Users in an Emergency Department. TOXICS 2022; 10:toxics10030112. [PMID: 35324737 PMCID: PMC8950993 DOI: 10.3390/toxics10030112] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 02/04/2023]
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.
Collapse
|
6
|
Tuan TA, Minh Duc N, Sy TV, Hung TM, Cuong T, Anh NQ, Luu VD, Thong PM. The clinical and subclinical features of spinal cord injury on magnetic resonance imaging of patients with N 2O intoxication. Neurol Int 2020; 12:8652. [PMID: 32922706 PMCID: PMC7461112 DOI: 10.4081/ni.2020.8652] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/15/2020] [Indexed: 12/11/2022] Open
Abstract
Nitrous oxide (N2O) is a weak anesthetic gas that was first used in 1844 in the field of dental anesthesia. However, currently, N2O is being abused for entertainment purposes in the form of N2O-filled balloons, called funky balls, which can cause many adverse effects, especially nervous system injury. This study aimed to investigate the detailed clinical and subclinical features associated with N2O intoxication. We retrospectively reviewed 47 patients diagnosed with N2O intoxication, from May 2018 to July 2019, and collected demographic data, clinical and laboratory tests, and spinal cord magnetic resonance imaging (MRI) findings. The mean time of funky ball use was 8.8 months, with a mean use of 36.3 balls per day. All patients presented with superficial sensory disorders. Reductions in muscle strength, decreased vibration sensation, and decreased or lost tendon reflexes were the most common clinical signs of N2O intoxication. Romberg sign and Lhermitte sign were observed in 39 patients (83%) and 21 patients (44.7%), respectively. Spinal cord lesions on MRI were observed in 32 patients (68.1%), which mostly presented with an inverted V sign. The total duration of N2O use, the number of days of using N2O per week, and the presence of Lhermitte sign (P<0.05) were significantly different between patients with and without spinal cord lesions on MRI. Serum levels of homocysteine and vitamin B12 were significantly different between the time of admission and discharge (P<0.05). Our study indicated that the days of using N2O per week was significantly associated with Spinal Cord Injuries (SCI) on MRI. According to the Receiver Operating Characteristic (ROC) curve analysis, a cutoff days of using per week value of 2.5 days could predict SCI with a sensitivity of 81.3%, a specificity of 73.3%, and an area under the ROC curve (AUC) of 0.813. Changes in the serum levels of homocysteine and vitamin B12 were effective markers for the evaluation of treatment response.
Collapse
Affiliation(s)
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City.,Department of Radiology, Children's Hospital 2, Ho Chi Minh City
| | - Than Van Sy
- Department of Radiology, Viet Duc Hospital, Hanoi
| | - Trinh Minh Hung
- Department of Radiology, Hanoi Medical University, Ha Noi, Vietnam
| | - Tran Cuong
- Department of Radiology, Hanoi Medical University, Ha Noi, Vietnam
| | - Nguyen Quang Anh
- Department of Radiology, Bach Mai Hospital, Hanoi.,Department of Radiology, Hanoi Medical University, Ha Noi, Vietnam
| | - Vu Dang Luu
- Department of Radiology, Bach Mai Hospital, Hanoi.,Department of Radiology, Hanoi Medical University, Ha Noi, Vietnam
| | - Pham Minh Thong
- Department of Radiology, Bach Mai Hospital, Hanoi.,Department of Radiology, Hanoi Medical University, Ha Noi, Vietnam
| |
Collapse
|
7
|
Roberts D, Farahmand P, Wolkin A. Nitrous Oxide Inhalant Use Disorder Preceding Symptoms Concerning for Primary Psychotic Illness. Am J Addict 2020; 29:525-527. [DOI: 10.1111/ajad.13048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 03/05/2020] [Accepted: 04/09/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Daniel Roberts
- Department of Psychiatry New York University New York New York
| | - Pantea Farahmand
- Department of Psychiatry New York University New York New York
- The Department of Veterans Affairs New York Harbor Healthcare System New York New York
| | - Adam Wolkin
- Department of Psychiatry New York University New York New York
- The Department of Veterans Affairs New York Harbor Healthcare System New York New York
| |
Collapse
|
8
|
Sheldon RJG, Reid M, Schon F, Poole NA. Just say N2O – nitrous oxide misuse: essential information for psychiatrists. BJPSYCH ADVANCES 2019. [DOI: 10.1192/bja.2019.57] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
SUMMARYNitrous oxide (N2O) misuse is widespread in the UK. Although it is well-known that it can cause devastating myeloneuropathy, psychiatric presentations are poorly described. There is little understanding of who it affects, how it presents, its mechanism of action and principles of treatment. We begin this article with a case study. We then review the literature to help psychiatrists understand this area and deal with this increasing problem, and make diagnosis and treatment recommendations. We describe a diagnostic pentad of weakness, numbness, paraesthesia, psychosis and cognitive impairment to alert clinicians to the need to urgently treat these patients. Nitrous oxide misuse is a pending neuropsychiatric emergency requiring urgent treatment with vitamin B12 to prevent potentially irreversible neurological and psychiatric symptoms.
Collapse
|
9
|
Fidalgo M, Prud’homme T, Allio A, Bronnec M, Bulteau S, Jolliet P, Victorri-Vigneau C. Nitrous oxide: What do we know about its use disorder potential? Results of the French Monitoring Centre for Addiction network survey and literature review. Subst Abus 2019; 40:33-42. [DOI: 10.1080/08897077.2019.1573210] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Martin Fidalgo
- Department of Pharmacology, Addictovigilance (Monitoring Centre for Addiction), Nantes University Hospital, Nantes, France
| | - Tony Prud’homme
- Department of Pedodonty, Nantes University Hospital, Nantes, France
- INSERM UMR U1246 SPHERE, Institut de Recherche en Santé 2, Nantes, France
| | - Adrien Allio
- Department of Pharmacology, Addictovigilance (Monitoring Centre for Addiction), Nantes University Hospital, Nantes, France
| | - Marie Bronnec
- INSERM UMR U1246 SPHERE, Institut de Recherche en Santé 2, Nantes, France
- Department of Addictology, Nantes University Hospital, Bâtiment Louis Philippe, Hôpital Saint Jacques, Nantes, France
| | - Samuel Bulteau
- INSERM UMR U1246 SPHERE, Institut de Recherche en Santé 2, Nantes, France
- Department of Psychiatry, Nantes University Hospital, Nantes, France
| | - Pascale Jolliet
- Department of Pharmacology, Addictovigilance (Monitoring Centre for Addiction), Nantes University Hospital, Nantes, France
- INSERM UMR U1246 SPHERE, Institut de Recherche en Santé 2, Nantes, France
| | - Caroline Victorri-Vigneau
- Department of Pharmacology, Addictovigilance (Monitoring Centre for Addiction), Nantes University Hospital, Nantes, France
- INSERM UMR U1246 SPHERE, Institut de Recherche en Santé 2, Nantes, France
| |
Collapse
|
10
|
Kang SW, Hong JM, Namgung DW, Choi YC. Neurological Manifestations of Myeloneuropathy in Patients with Nitrous Oxide Intoxication. J Clin Neurol 2018; 15:116-117. [PMID: 30375766 PMCID: PMC6325376 DOI: 10.3988/jcn.2019.15.1.116] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 08/01/2018] [Accepted: 08/01/2018] [Indexed: 02/06/2023] Open
Affiliation(s)
- Sung Woo Kang
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Man Hong
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Wook Namgung
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Young Chul Choi
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
| |
Collapse
|
11
|
Yuan JL, Wang SK, Jiang T, Hu WL. Nitrous oxide induced subacute combined degeneration with longitudinally extensive myelopathy with inverted V-sign on spinal MRI: a case report and literature review. BMC Neurol 2017; 17:222. [PMID: 29282001 PMCID: PMC5745895 DOI: 10.1186/s12883-017-0990-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 11/26/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Nitrous oxide (N2O), a long-standing anesthetic, is also neurotoxic by interfering with the bioavailability of vitamin B12 if abused. A few case studies have reported the neurological and psychiatric complications of N2O. CASE PRESENTATION Here, we reported a patient of N2O induced subacute combined degeneration (SCD) with longitudinally extensive myelopathy with inverted V-sign exhibiting progressive limb paresthesia and unsteady gait. CONCLUSIONS This case raises the awareness of an important mechanism of neural toxicity of N2O, and clinical physicians should be well recognized this in the field of substance-related disorders.
Collapse
Affiliation(s)
- Jun Liang Yuan
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Shuang Kun Wang
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Tao Jiang
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China.
| | - Wen Li Hu
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China.
| |
Collapse
|
12
|
Leth PM, Astrup BS. Suffocation caused by plastic wrap covering the face combined with nitrous oxide inhalation. Forensic Sci Med Pathol 2017. [PMID: 28631111 DOI: 10.1007/s12024-017-9887-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Suicide using a combination of a plastic bag over the head and inhalation of a non-irritating gas, such as helium, argon or nitrogen, has been reported in the literature. Here an unusual suicide method in a 17-year old man by suffocation from covering the face with household plastic wrap, combined with nitrous oxide inhalation, is presented. The case was reviewed based on police, autopsy and hospital reports. A PubMed search for scientific literature related to nitrous oxide abuse and suicide by suffocation was performed and our findings discussed in relation to the scientific literature found. The deceased was a 17-year old man who was found with the nose and mouth closed with a piece of kitchen plastic wrap. The plastic wrap had been removed prior to autopsy. Autopsy findings were suggestive of asphyxia, but were otherwise negative. Nitrous oxide was detected in the brain and lung tissue with headspace-gas chromatography-mass spectrometry (headspace-GCMS). The cause of death was assumed to be suffocation caused by plastic wrap covering the face, combined with nitrous oxide inhalation. Suicide was suspected because of a history of depression for several months. Nitrous oxide, also known as laughing gas, has a euphoric effect and is used as a recreational inhalant drug that can be purchased legally. Deaths caused by recreational nitrous oxide abuse are rare but may occur if used in combination with a plastic bag over the head. This is the first report of suicide by suffocation by external obstruction combined with nitrous oxide inhalation.
Collapse
Affiliation(s)
- Peter Mygind Leth
- Department of Forensic Medicine, University of Southern Denmark, J.B.Winsløws Vej 17B, 5000, Odense C, Denmark.
| | - Birgitte Schmidt Astrup
- Department of Forensic Medicine, University of Southern Denmark, J.B.Winsløws Vej 17B, 5000, Odense C, Denmark
| |
Collapse
|
13
|
Abstract
Respiratory conditions are some of the most common indications for admission to critical care units. Psychiatric disorders and symptoms are highly comorbid with lung disease. They can occur as a risk factor to lung disease, as a co-occurring condition, as a consequence of a pulmonary condition, or as a treatment side effect either from medications or assistive devices. Patients can experience a myriad of mood, anxiety, and cognitive disorder symptoms and conditions in critical care units. Intensivists and psychiatrists must be aware of the interplay between pulmonary and psychiatric symptoms as well as medication effects and interactions.
Collapse
Affiliation(s)
- Yelizaveta Sher
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, 401 Quarry Road, Suite 2320, Stanford, CA 94305, USA.
| |
Collapse
|
14
|
Ehirim EM, Naughton DP, Petróczi A. No Laughing Matter: Presence, Consumption Trends, Drug Awareness, and Perceptions of "Hippy Crack" (Nitrous Oxide) among Young Adults in England. Front Psychiatry 2017; 8:312. [PMID: 29403400 PMCID: PMC5786547 DOI: 10.3389/fpsyt.2017.00312] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 12/27/2017] [Indexed: 11/22/2022] Open
Abstract
In clinical settings, nitrous oxide gas is a safe anesthetic used during childbirth, in dentistry, and to relieve anxiety in emergencies. Colloquially known as "hippy crack"' or "laughing gas," it is increasingly taken recreationally for its euphoric and relaxing effects and hallucinogenic properties. Using a self-reported survey, we gathered quantitative and qualitative information on users and non-users of hippy crack among a young population regarding: consumption patterns, knowledge, risk awareness and intentions toward future abuse. Quantitative responses from a total of 140 participants were analyzed for frequencies and relationships, whereas qualitative data were evaluated via identifying the reoccurring themes. Overall, 77.1% (n = 108) had heard of hippy crack and 27.9% (n = 39) admitted to past-year use. Prior users mostly indicated intended future use, had an average low number of past-year uses but some with > 20 occasions, had a varied number of inhalations per occasion (often 1-10) with an effect lasting up to 5 min, and a majority preferred social rather than lone use. For non-users, 79.2% said they would take hippy crack with the vast majority (94%) preferring a social setting. The results show a concerning gap between available evidence and awareness of side effects. Despite serious reported side effects, including psychosis and myeloneuropathy-especially on the young developing brain-only a minority (29.3%) was aware of any side effects. In contrast, in a hypothetical scenario depicting a first social encounter with hippy crack, the qualitative responses were in contrast to qualitative outcomes revealing that participants would try (n = 30)/not try (n = 25) it, would feel under pressure to try it (n = 6) with only 11 opting to exit the situation. In summary, this first report of trends and perceptions of the use of hippy crack among young adults in the England highlights a lack of concern with side effects, coupled to a willingness to partake. Because typical users are young with risks to the still developing brain, education about the nitrous oxide abuse is warranted to prevent impaired brain development. Further studies to investigate the possible effects of nitrous oxide on the developing brain in young adults would advance meaningful prevention.
Collapse
Affiliation(s)
- Esther M Ehirim
- School of Life Sciences, Pharmacy and Chemistry, Kingston University, Kingston upon Thames, United Kingdom
| | - Declan P Naughton
- School of Life Sciences, Pharmacy and Chemistry, Kingston University, Kingston upon Thames, United Kingdom
| | - Andrea Petróczi
- School of Life Sciences, Pharmacy and Chemistry, Kingston University, Kingston upon Thames, United Kingdom
| |
Collapse
|
15
|
Mancke F, Kaklauskaitė G, Kollmer J, Weiler M. Psychiatric comorbidities in a young man with subacute myelopathy induced by abusive nitrous oxide consumption: a case report. Subst Abuse Rehabil 2016; 7:155-159. [PMID: 27729826 PMCID: PMC5047713 DOI: 10.2147/sar.s114404] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Nitrous oxide (N2O), a long-standing anesthetic, is known for its recreational use, and its consumption is on the rise. Several case studies have reported neurological and psychiatric complications of N2O use. To date, however, there has not been a study using standardized diagnostic procedures to assess psychiatric comorbidities in a patient consuming N2O. Here, we report about a 35-year-old male with magnetic resonance imaging confirmed subacute myelopathy induced by N2O consumption, who suffered from comorbid cannabinoid and nicotine dependence as well as abuse of amphetamines, cocaine, lysergic acid diethylamide, and ketamine. Additionally, there was evidence of a preceding transient psychotic and depressive episode induced by synthetic cannabinoid abuse. In summary, this case raises awareness of an important mechanism of neural toxicity, with which physicians working in the field of substance-related disorders should be familiar. In fact, excluding N2O toxicity in patients with recognized substance-related disorders and new neurological deficits is compulsory, as untreated for months the damage to the nervous system is at risk of becoming irreversible.
Collapse
Affiliation(s)
- Falk Mancke
- Department of Neurology; Department of General Psychiatry, Center for Psychosocial Medicine
| | | | - Jennifer Kollmer
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | | |
Collapse
|
16
|
Garakani A, Jaffe RJ, Savla D, Welch AK, Protin CA, Bryson EO, McDowell DM. Neurologic, psychiatric, and other medical manifestations of nitrous oxide abuse: A systematic review of the case literature. Am J Addict 2016; 25:358-69. [PMID: 27037733 DOI: 10.1111/ajad.12372] [Citation(s) in RCA: 169] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 01/28/2016] [Accepted: 03/11/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND/OBJECTIVES Nitrous oxide (N2 O) is known to have abuse potential, although debate regarding the toxic effects of such abuse continues. Our objective was to review the case literature and present the neurologic, psychiatric and medical consequences of N2 O abuse. METHODS A systematic literature review was completed for case reports using keywords "nitrous oxide" with "abuse/abusing" or "misuse/misusing" or "overuse/overusing" or "addiction." Non-English-language cases and cases not involving direct toxic effects of N2 O were excluded as were commentaries or personal essays. Clinical presentation, frequency of N2 O abuse, laboratory studies, imaging, ancillary tests, treatments and outcomes were collected from case reports. RESULTS Our review returned 335 Pubmed, 204 Web of Science, 73 PsycINFO, 6 CINAHL, 55 EMBASE and 0 Grey Literature results, and after exclusion and removal of duplicates, 91 individual cases across 77 publications were included. There were also 11 publications reporting 29 cases of death related to N2 O abuse. The majority of cases (N = 72) reported neurologic sequelae including myeloneuropathy and subacute combined degeneration, commonly (N = 39) with neuroimaging changes. Psychiatric (N = 11) effects included psychosis while other medical effects (N = 8) included pneumomediastinum and frostbite. Across all cases N2 O abuse was correlated with low or low-normal Vitamin B12 (cyanocobalamin) levels (N = 52) and occasionally elevated homocysteine and methylmalonic acid. CONCLUSIONS/SCIENTIFIC SIGNIFICANCE N2 O abuse represents a significant problem because of the difficulty involved with identification and the toxicity related to chronic abuse including possible death. Health professionals should be aware of the toxic effects of N2 O and be able to identify potential N2 O abuse. (Am J Addict 2016;25:358-369).
Collapse
Affiliation(s)
- Amir Garakani
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.,Silver Hill Hospital, New Canaan, Connecticut
| | - Robert J Jaffe
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Dipal Savla
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alison K Welch
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Caroline A Protin
- Department of Anesthesiology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Ethan O Bryson
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | | |
Collapse
|
17
|
van Amsterdam J, Nabben T, van den Brink W. Recreational nitrous oxide use: Prevalence and risks. Regul Toxicol Pharmacol 2015; 73:790-6. [PMID: 26496821 DOI: 10.1016/j.yrtph.2015.10.017] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 10/14/2015] [Accepted: 10/19/2015] [Indexed: 02/02/2023]
Abstract
Nitrous oxide (N2O; laughing gas) is clinically used as a safe anesthetic (dentistry, ambulance, childbirth) and appreciated for its anti-anxiety effect. Since five years, recreational use of N2O is rapidly increasing especially in the dance and festival scene. In the UK, N2O is the second most popular recreational drug after cannabis. In most countries, nitrous oxide is a legal drug that is widely available and cheap. Last month prevalence of use among clubbers and ravers ranges between 40 and almost 80 percent. Following one inhalation, mostly from a balloon, a euphoric, pleasant, joyful, empathogenic and sometimes hallucinogenic effect is rapidly induced (within 10 s) and disappears within some minutes. Recreational N2O use is generally moderate with most users taking less than 10 balloons of N2O per episode and about 80% of the users having less than 10 episodes per year. Side effects of N2O include transient dizziness, dissociation, disorientation, loss of balance, impaired memory and cognition, and weakness in the legs. When intoxicated accidents like tripping and falling may occur. Some fatal accidents have been reported due to due to asphyxia (hypoxia). Heavy or sustained use of N2O inactivates vitamin B12, resulting in a functional vitamin B12 deficiency and initially causing numbness in fingers, which may further progress to peripheral neuropathy and megaloblastic anemia. N2O use does not seem to result in dependence. Considering the generally modest use of N2O and its relative safety, it is not necessary to take legal measures. However, (potential) users should be informed about the risk of vitamin B12-deficiency related neurological and hematological effects associated with heavy use.
Collapse
Affiliation(s)
- Jan van Amsterdam
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands.
| | - Ton Nabben
- Bonger Institute for Criminology, University of Amsterdam, P.O. Box 1030, 1000 BA Amsterdam, The Netherlands
| | - Wim van den Brink
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands; Amsterdam Institute for Addiction Research, Academic Medical Center, P.O. Box 75867, 1070 AW Amsterdam, The Netherlands
| |
Collapse
|