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Chapter 7 - Nitrous Oxide (N2O)

from Part II - Drugs with Primarily Depressant Effects

Published online by Cambridge University Press:  06 October 2022

Dima Abdulrahim
Affiliation:
Programme Manager and Principal Researcher for the NEPTUNE Project, Central and North West London NHS Foundation Trust
Owen Bowden-Jones
Affiliation:
Consultant Addiction Psychiatrist, Central and North West London NHS Foundation Trust
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Summary

The evidence on the management of the acute and chronic harms associated with the recreational use of nitrous oxide (N2O) is limited and consists mainly of case reports, with occasional experimental studies into acute effects. There are few findings on acute harms and interventions relating to the use of the drug, but consistent findings on the chronic effects of prolonged nitrous oxide use.

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Publisher: Cambridge University Press
Print publication year: 2022

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References

Savage, S, Daqing, MD. The neurotoxicity of nitrous oxide: the facts and ‘putative’ mechanisms. Brain Sci 2014;4:7390. https://doi.org/10.3390/brainsci4010073CrossRefGoogle ScholarPubMed
Berkowitz, BA, Finck, AD, Ngai, SH. Nitrous oxide analgesia: reversal by naloxone and development of tolerance. J Pharmacol Exp Ther 1977;203:539547.Google Scholar
Savage, S, Daqing, MD. The neurotoxicity of nitrous oxide: the facts and ‘putative’ mechanisms. Brain Sci 2014;4:7390. https://doi.org/10.3390/brainsci4010073Google Scholar
Brouette, T, Anton, R. Clinical review of inhalants. Am J Addict 2001;10(1):7994.Google Scholar
Brouette, T, Anton, R. Clinical review of inhalants. Am J Addict 2001;10(1):7994.Google Scholar
Ghobrial, GM, Dalyai, R, Flanders, AE, Harrop, J. Nitrous oxide myelopathy posing as spinal cord injury. J Neurosurg Spine 2012;16(5):489491. https://doi.org/10.3171/2012.2.SPINE11532Google Scholar
Nunn, JF. Clinical aspects of the interaction between nitrous oxide and vitamin B12. Br J Anaesthesia 1987;59(1):313.CrossRefGoogle ScholarPubMed
Amsterdama J, , den Brink W, . Recreational nitrous oxide use: prevalence and risks. Regul Toxicol Pharmacol 2015;73(3):790796.Google Scholar
Advisory Council on the Misuse of Drugs (ACMD). Consideration of the Novel Psychoactive Substances (Legal Highs). London, Home Office, October 2011.Google Scholar
Garakani, A, Jaffe, RJ, Savla, D, et al. Neurologic, psychiatric, and other medical manifestations of nitrous oxide abuse: a systematic review of the case literature. Am J Addict 2016;25:358369.Google Scholar
Gillman, MA, Lichtigfeld, FJ, Young, TN. Psychotropic analgesic nitrous oxide for alcoholic withdrawal states. Cochrane Database Syst Rev 2007;18(2):CD005190.Google Scholar
Kripke, BJ, Hechtman, HB. Nitrous oxide for pentazocine addiction and for intractable pain: report of case. Anesth Analg 1972;51(4):520527.Google Scholar
Lichtigfeld, FJ, Gillman, MA. The treatment of alcoholic withdrawal states with oxygen and nitrous oxide. S Afr Med J 1982;61(10):349351.Google Scholar
Gillman, MA, Lichtigfeld, FJ. Analgesic nitrous oxide: adjunct to clonidine for opioid withdrawal. Am J Psychiatry 1985;142(6):784785.Google Scholar
Carey, C, Clark, A, Saner, A. Excellent results with analgesic nitrous oxide for addictive withdrawal states in general practice. S Afr Med J 1991;79(8):516.Google Scholar
Alho, H, Methuen, T, Paloheimo, M, et al. Nitrous oxide has no effect in the treatment of alcohol withdrawal syndrome: a double-blind placebo-controlled randomized trial. J Clin Psychopharmacol 2003;23(2):211214.CrossRefGoogle ScholarPubMed
Sanders, RD, Weimann, J, Maze, M. Biologic effects of nitrous oxide: a mechanistic and toxicologic review. Anesthesiology 2008;109(4):707722.Google Scholar
Advisory Council on the Misuse of Drugs (ACMD). Consideration of the Novel Psychoactive Substances (Legal Highs). London, Home Office, October 2011.Google Scholar
Kaar, SJ, Ferris, J, Waldron, J, Devaney, M, Ramsey, J, Winstock, AR. Up: the rise of nitrous oxide abuse. An international survey of contemporary nitrous oxide use. J Psychopharmacol 2016(online). https://doi.org/10.1177/0269881116632375Google Scholar
Chen, R, Liao, M, Ou, J. Laughing gas inhalation in Chinese youth: a public health issue. Lancet Public Health 2018;3(10):e465. https://doi.org/10.1016/S2468-2667(18)30134-8Google Scholar
Gillman, M. Polydrug abuse associated with nitrous oxide causes death. Oxf Med Case Reports 2016;6:117.Google Scholar
Mancke, F, Kaklauskaite, 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 Rehab 2016;7:155159.Google Scholar
van Amsterdam, J, den Brink, W. Recreational nitrous oxide use: prevalence and risks. Reg Toxicol Pharmacol 2015;73(3):790796.Google Scholar
van Amsterdam, J, den Brink, W. Recreational nitrous oxide use: prevalence and risks. Reg Toxicol Pharmacol 2015;73(3):790796.Google Scholar
Cheng, HM, Park, JH, Hernstadt, D. Subacute combined degeneration of the spinal cord following recreational nitrous oxide use. BMJ Case Rep 2013;8: bcr2012008509. https://doi.org/10.1136/ bcr-2012-008509Google Scholar
Ng, J, O’Grady, G, Pettit, T, et al. Nitrous oxide use in first-year students at Auckland University. Lancet 2003;361:13491350.Google Scholar
Cheng, HM, Park, JH, Hernstadt, D. Subacute combined degeneration of the spinal cord following recreational nitrous oxide use. BMJ Case Rep 2013;8: bcr2012008509. https://doi.org/10.1136/ bcr-2012-008509Google Scholar
Ng, J, O’Grady, G, Pettit, T, et al. Nitrous oxide use in first-year students at Auckland University. Lancet 2003;361:13491350.Google Scholar
Wackawik, A, Luzzio, C, Juhasz-Poscine, K, et al. Myelo-neuropathy from nitrous oxide abuse: unusually high methylmalonic acid and homocysteine level. Wis Med J 2003;102:4345.Google Scholar
Gillman, MA. Nitrous oxide abuse in perspective. Clin Neuropharmacol 1992;15:297306.Google Scholar
Cartner, M, Sinnott, M, Silburn, P. Paralysis caused by ‘nagging’. Med J Aust 2007;187:366367.Google Scholar
Alt, RS, Morrissey, RP, Gang, MA, et al. Severe myeloneuropathy from acute high-dose nitrous oxide(N2O) abuse. J Emerg Med 2011;41:378380.Google Scholar
Miller, MA, Martinez, V, McCarthy, R, et al. Nitrous oxide ‘whippit’ abuse presenting as clinical B12 deficiency and ataxia. Am J Emerg Med 2004;22:124.Google Scholar
Shulman, RM, Geraghty, TJ, Tadros, M. A case of unusual substance abuse causing myeloneuropathy. Spinal Cord 2007;45:314317.Google Scholar
Ng, J, Nanging FR, . Lancet 2002;360(9330):384.Google Scholar
Tatum, WO, Bui, DD, Grant, EG, et al. Pseudo-Guillain-Barre syndrome due to ‘whippet’-induced myeloneuropathy. J Neuroimaging 2010;20:400401.Google Scholar
Lin, RJ, Chen, HF, Chang, YC, et al. Subacute combined degeneration caused by nitrous oxide intoxication: case reports. Acta Neurol Taiwan 2011;20:129137.Google Scholar
Vasconcelos, OM, Poehm, EH, McCarter, RJ, et al. Potential outcome factors in subacute combined degeneration: review of observational studies. J Gen Intern Med 2006;21:10631068.Google Scholar
Dohrn, CS, Lichtor, JL, Finn, RS, et al. Subjective and psychomotor effects of nitrous oxide in healthy volunteers. Behav Pharmacol 1992;3(1):1930.Google Scholar
Sanders, RD, Weimann, J, Maze, M. Biologic effects of nitrous oxide: a mechanistic and toxicologic review. Anesthesiology 2008;109(4):707722.Google Scholar
van Amsterdam, J, Nabben, T, van den Brink W. Recreational nitrous oxide use: prevalence and risks. Regul Toxicol Pharmacol 2015;73(3):790796.Google Scholar
Advisory Council on the Misuse of Drugs (ACMD). Consideration of the Novel Psychoactive Substances (Legal Highs). London, Home Office, October 2011.Google Scholar
Lichtigfeld, FJ, Gillman, MA. The treatment of alcoholic withdrawal states with oxygen and nitrous oxide. S Afr Med J 1982;61(10):349351.Google Scholar
Glijn, NHP, van der Linde, D, Ertekin, E, van Burg, PLM, Grimbergen, YAM, Libourel, EJ. Is nitrous oxide really that joyful? Neth J Med 2017;75(7):304306.Google ScholarPubMed
Advisory Council on the Misuse of Drugs (ACMD). Consideration of the Novel Psychoactive Substances (Legal Highs). London, Home Office, October 2011.Google Scholar
Lichtigfeld, FJ, Gillman, MA. The treatment of alcoholic withdrawal states with oxygen and nitrous oxide. S Afr Med J 1982;61(10):349351.Google Scholar
Glijn, NHP, van der Linde, D, Ertekin, E, van Burg, PLM, Grimbergen, YAM, Libourel, EJ. Is nitrous oxide really that joyful? Neth J Med 2017;75(7):304306.Google Scholar
Kaar, SJ, Ferris, J, Waldron, J, Devaney, M, Ramsey, J, Winstock, AR. Up: the rise of nitrous oxide abuse. An international survey of contemporary nitrous oxide use. J Psychopharmacol 2016(online). https://doi.org/10.1177/0269881116632375Google Scholar
Lundin, MS, Cherian, J, Andrew, MN, et al. One month of nitrous oxide abuse causing acute vitamin B 12 deficiency with severe neuropsychiatric symptoms BMJ Case Reports CP 2019;12:bcr-2018-228001.Google Scholar
Lundin, MS, Cherian, J, Andrew, MN, et al. One month of nitrous oxide abuse causing acute vitamin B 12 deficiency with severe neuropsychiatric symptoms BMJ Case Reports CP 2019;12:bcr-2018-228001.Google Scholar
Walker, DJ, Zacny, JP. Within- and between-subject variability in the reinforcing and subjective effects of nitrous oxide in healthy volunteers. Drug Alcohol Depend 2001;64(1):8596.Google Scholar
Walker, DJ, Zacny, JP. Within- and between-subject variability in the reinforcing and subjective effects of nitrous oxide in healthy volunteers. Drug Alcohol Depend 2001;64(1):8596.Google Scholar
Dohrn, CS, Lichtor, JL, Finn, RS, et al. Subjective and psychomotor effects of nitrous oxide in healthy volunteers. Behav Pharmacol 1992;3(1):1930.Google Scholar
Zacny, JP, Jun, JM. Lack of sex differences to the subjective effects of nitrous oxide in healthy volunteers. Drug Alcohol Depend 2010;112(3):251254.Google Scholar
van Amsterdam, J, den Brink, W. Recreational nitrous oxide use: prevalence and risks. Reg Toxicol Pharmacol 2015;73(3):790796.Google Scholar
Bennett, CR. Nitrous oxide hallucinations. J Am Dent Assoc 1980;101:595597.Google Scholar
Jastak, JT, Malamed, SF. Nitrous oxide sedation and sexual phenomena. J Am Dent Assoc 1980;101:3840.Google Scholar
Lambert, C. Sexual phenomena hypnosis and nitrous oxide sedation. J Am Dent Assoc 1982;105:990991.Google Scholar
Lichtigfeld, FJ, Gillman, MA. The treatment of alcoholic withdrawal states with oxygen and nitrous oxide. S Afr Med J 1982;61(10):349351.Google Scholar
Randhawa, G, Bodenham, A. The increasing recreational use of nitrous oxide: history revisited. Br J Anaesth 2016;116(3):321324. https://doi.org/10.1093/bja/aev297Google Scholar
Wagner, SA, Clark, MA, Wesche, DL, Doedens, DJ, Lloyd, AW. Asphyxial deaths from the recreational use of nitrous oxide. J Forensic Sci 1992;37(4):10081015.Google Scholar
Gillman, M. Polydrug abuse associated with nitrous oxide causes death. Oxf Med Case Reports 2016;2016(6):117.Google Scholar
Advisory Council on the Misuse of Drugs (ACMD). Consideration of the Novel Psychoactive Substances (Legal Highs). London, Home Office, October 2011.Google Scholar
Garakani, A, Jaffe, RJ, Savla, D, et al. Neurologic, psychiatric, and other medical manifestations of nitrous oxide abuse: a systematic review of the case literature. Am J Addict 2016;25:358369.CrossRefGoogle ScholarPubMed
Dohrn, CS, Lichtor, JL, Finn, RS, et al. Subjective and psychomotor effects of nitrous oxide in healthy volunteers. Behav Pharmacol 1992;3(1):1930.Google Scholar
Hwang, JC, Himel, HN, Edlich, RF. Frostbite of the face after recreational misuse of nitrous oxide. Burns 1996;22(2):152153.Google Scholar
Brouette, T, Anton, R. Clinical review of inhalants. Am J Addict 2001;10(1):7994.CrossRefGoogle ScholarPubMed
Sanders, RD, Weimann, J, Maze, M. Biologic effects of nitrous oxide: a mechanistic and toxicologic review. Anesthesiology 2008;109(4):707722.Google Scholar
Rosenberg, H, Orkin, FK, Springstead, J. Abuse of nitrous oxide. Anesth Analg 1979;58(2):104106.Google Scholar
Ghobrial, GM, Dalyai, R, Flanders, AE, Harrop, J. Nitrous oxide myelopathy posing as spinal cord injury. J Neurosurg Spine 2012;16(5):489491. https://doi.org/10.3171/2012.2.SPINE11532Google Scholar
Chadly, A, Marc, B, Barres, D, Durigon, M. Suicide by nitrous oxide poisoning. Am J Forensic Med Pathol 1989;10(4):330331.Google Scholar
Suruda, AJ, McGlothlin, JD. Fatal abuse of nitrous oxide in the workplace. J Occup Med 1990;32(8):682684.Google Scholar
Pasternak, JJ, Lanier, WL. Is nitrous oxide use appropriate in neurosurgical and neurologically at-risk patients? Curr Opin Anaesthesiol 2010;23(5):544550.Google Scholar
Sanders, RD, Weimann, J, Maze, M. Biologic effects of nitrous oxide: a mechanistic and toxicologic review. Anesthesiology 2008;109(4):707722.Google Scholar
Randhawa, G, Bodenham, A. The increasing recreational use of nitrous oxide: history revisited. Br J Anaesth 2016;116(3):321324. https://doi.org/10.1093/bja/aev297Google Scholar
Garakani, A, Jaffe, RJ, Savla, D, et al. Neurologic, psychiatric, and other medical manifestations of nitrous oxide abuse: a systematic review of the case literature. Am J Addict 2016;25:358369.Google Scholar
Rosenberg, H, Orkin, FK, Springstead, J. Abuse of nitrous oxide. Anesth Analg 1979;58(2):104106.Google Scholar
Zacny, JP, Walker, DJ, Derus, LM. Choice of nitrous oxide and its subjective effects in light and moderate drinkers. Drug Alcohol Depend 2008;98(1–2):163168.Google Scholar
Mancke, F, Kaklauskaite, 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 Rehab 2016:7:155159.Google Scholar
Sheldon, R, Reid, M, Schon, F, Poole, N. Just say N2O – nitrous oxide misuse: essential information for psychiatrists. BJPsych Advances 2020;26(2):7281. https://doi.org/10.1192/bja.2019.57Google Scholar
van Amsterdam, J, den Brink, W. Recreational nitrous oxide use: prevalence and risks. Regul Toxicol Pharmacol 2015;73(3):790796.CrossRefGoogle ScholarPubMed
Gillman, MA. Nitrous oxide abuse in perspective. Clin Neuropharmacol 1992;15:297306.Google Scholar
Gilman, MA. Nitrous oxide – an opioid agent: review of the evidence. Am J Med 1986; 81:97102.Google Scholar
Mancke, F, Kaklauskaite, 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 Rehab 2016;7:155159.Google Scholar
Tym, MK, Alexander, J. Nitrous oxide induced manic relapse. Aust NZ J Psychiatry 2011;45(11):1002.Google Scholar
Sethi, NK, Mullin, P, Torgovnick, J, Capasso, G. Nitrous oxide ‘whippit’ abuse presenting with cobalamin responsive psychosis. J Med Toxicol 2006;2(2):7174.Google Scholar
Cousaert, C, Heylens, G, Audenaert, K. Laughing gas abuse is no joke: an overview of the implications for psychiatric practice. Clin Neurol Neurosurg 2013;115(7):859862.Google Scholar
Garakani, A, Jaffe, RJ, Savla, D, et al. Neurologic, psychiatric, and other medical manifestations of nitrous oxide abuse: a systematic review of the case literature. Am J Addict 2016;25:358369.Google Scholar
Miller, MA, Martinez, V, McCarthy, R, et al. Nitrous oxide ‘whippit’ abuse presenting as clinical B12 deficiency and ataxia. Am J Emerg Med 2004;22:124.Google Scholar
Stacy, CB, Di Rocco, A, Gould, RJ. Methionine in the treatment of nitrous-oxide-induced neuropathy and myeloneuropathy. J Neurol 1992;239:401403.Google Scholar
Luis-Ferdinand, RT. Myelotoxic, neurotoxic and reproductive adverse effects of nitrous oxide. Adverse Drug React Toxicol Rev 1994;13:193206.Google Scholar
Al-Sadawi, M, Hidalgo, C, Chinyere, A, Apoorva, J, Modupe, O, McFarlane, SI. Inhaled nitrous oxide ‘whip-its!’ causing subacute combined degeneration of spinal cord. Am J Med Case Rep 2018;6(12):237240. https://doi.org/10.12691/ajmcr-6-12-3CrossRefGoogle Scholar
Van Amsterdam, J, Nabben, T, van den Brink, W. Recreational nitrous oxide use: prevalence and risks. Regul Toxicol Pharmacol 2015;73:790796.Google Scholar
Stabler, SP. Vitamin B12 deficiency. N Engl J Med 2013;368:20412042.Google Scholar
Massey, TH, Pickersgill, TT, Peal, KJ. Nitrous oxide misuse and vitamin B12 deficiency. BMJ Case Rep 2016 (online). https://doi.org/10.1136/bcr-2016-215728Google Scholar
Cartner, M, Sinnott, M, Silburn, P. Paralysis caused by ‘nagging’. Med J Aust 2007;187:366367.Google Scholar
Garakani, A, Jaffe, RJ, Savla, D, et al. Neurologic, psychiatric, and other medical manifestations of nitrous oxide abuse: a systematic review of the case literature. Am J Addict 2016;25:358369.Google Scholar
Oussalah, A, Julien, M, Levy, J, et al. Global burden related to nitrous oxide exposure in medical and recreational settings: a systematic review and individual patient data meta-analysis. J Clin Med 2019;8:551.Google Scholar
Oussalah, A, Julien, M, Levy, J, et al. Global burden related to nitrous oxide exposure in medical and recreational settings: a systematic review and individual patient data meta-analysis. J Clin Med 2019;8:551.Google Scholar
van Amsterdam, J, van den Brink, W. Recreational nitrous oxide use: prevalence and risks. Regul Toxicol Pharmacol 2015;73(3):790796.Google Scholar
Richardson, PG. Peripheral neuropathy following nitrous oxide abuse. Emerg Med Australas 2010;22(1):8890.Google Scholar
Ghobrial, GM, Dalyai, R, Flanders, AE, Harrop, J. Nitrous oxide myelopathy posing as spinal cord injury. J Neurosurg Spine 2012;16(5):489491. https://doi.org/10.3171/2012.2.SPINE11532Google Scholar
Cheng, HM, Park, JH, Hernstadt, D. Subacute combined degeneration of the spinal cord following recreational nitrous oxide use. BMJ Case Rep 2013;8:bcr2012008509. https://doi.org/10.1136/ bcr-2012-008509Google Scholar
Miller, MA, Martinez, V, McCarthy, R, et al. Nitrous oxide ‘whippit’ abuse presenting as clinical B12 deficiency and ataxia. Am J Emerg Med 2004;22:124.Google Scholar
Shulman, RM, Geraghty, TJ, Tadros, M. A case of unusual substance abuse causing myeloneuropathy. Spinal Cord 2007;45:314317.Google Scholar
Tatum, WO, Bui, DD, Grant, EG, et al. Pseudo-Guillain-Barre syndrome due to ‘whippet’-induced myeloneuropathy. J Neuroimaging 2010;20:400401.Google Scholar
Richardson, PG. Peripheral neuropathy following nitrous oxide abuse. Emerg Med Australas 2010;22(1):8890.CrossRefGoogle ScholarPubMed
Diamond, AL, Diamond, R, Freedman, SM, Thomas, FP. ‘Whippets’-induced cobalamin deficiency manifesting as cervical myelopathy. J Neuroimaging 2004;14(3):277280.Google Scholar
Hsu, CK, Chen, YQ, Lung, VZ, His, SC, Lo, HC, Shyu, HY. Myelopathy and polyneuropathy caused by nitrous oxide toxicity: a case report. Am J Emerg Med 2012;30(6):1016.e36. https://doi.org/10.1016/j. ajem.2011.05.001Google Scholar
Probasco, JC, Felling, RJ, Carson, JT, Dorsey, ER, Niessen, TM. Teaching neuroimages: myelopathy due to B12 deficiency in long-term colchicine treatment and nitrous oxide misuse. Neurology 2011;77(9):e51. https://doi.org/10.1212/WNL.0b013e31822c910fGoogle Scholar
Sotirchos, ES, Saidha, S, Becker, D. Neurological picture: nitrous oxide-induced myelopathy with inverted V-sign on spinal MRI. J Neurol Neurosurg Psychiatry 2012;83(9):915916.Google Scholar
Waters, MF, Kang, GA, Mazziotta, JC, DeGiorgio, CM. Nitrous oxide inhalation as a cause of cervical myelopathy. Acta Neurol Scand 2005;12(4):270272.Google Scholar
Massey, TH, Pickersgill, TT, Peall, JK. Nitrous oxide misuse and vitamin B12 deficiency. Case Rep 2016;2016: bcr2016215728.Google Scholar
Richardson, PG. Peripheral neuropathy following nitrous oxide abuse. Emerg Med Australas 2010;22(1):8890.Google Scholar
Miller, MA, Martinez, V, McCarthy, R, et al. Nitrous oxide ‘whippit’ abuse presenting as clinical B12 deficiency and ataxia. Am J Emerg Med 2004;22:124.Google Scholar
Dong X, Ba F, Wang R, , Zheng D. Imaging appearance of myelopathy secondary to nitrous oxide abuse: a case report and review of the literature. Int J Neurosci 2019;129(3):225229https://doi.org/10.1080/00207454.2018.1526801Google Scholar
Williamson, J, Huda, S, Damodaran, D. Nitrous oxide myelopathy with functional vitamin B 12 deficiency. BMJ Case Rep CP 2019;12:e227439.Google Scholar
Miller, MA, Martinez, V, McCarthy, R, et al. Nitrous oxide ‘whippit’ abuse presenting as clinical B12 deficiency and ataxia. Am J Emerg Med 2004;22:124.Google Scholar
Glijn, NHP, van der Linde, D, Ertekin, E, van Burg, PLM, Grimbergen, YAM, Libourel, EJ. Is nitrous oxide really that joyful? Neth J Med 2017;75(7):304306.Google Scholar
Garriott, J, Petty, CS. Death from inhalant abuse: toxicological and pathological evaluation of 34 cases. Clin Toxicol 1980;16:305315.Google Scholar
Bowen, SE, Daniel, J, Balster, RL. Deaths associated with inhalant abuse in Virginia from 1987 to 1996. Drug Alcohol Depend 1999;53:239245.Google Scholar
Suruda, AJ, McGlothlin, JD. Fatal abuse of nitrous oxide in the workplace. J Occup Med 1990;32:682684.Google Scholar
Winstock, AR. Ferris, JA. Nitrous oxide causes peripheral neuropathy in a dose-dependent manner among recreational users. J Psychopharmacol 2020;34(2):229236https://doi.org/10.1177/0269881119882532Google Scholar
Garakani, A, Jaffe, RJ, Savla, D, et al. Neurologic, psychiatric, and other medical manifestations of nitrous oxide abuse: a systematic review of the case literature. Am J Addict 2016;25:358369.Google Scholar
Stabler, SP. Vitamin B12 deficiency. N Engl J Med 2013;368:20412042.Google Scholar
Massey, TH, Pickersgill, TT, Peal, KJ. Nitrous oxide misuse and Vitamin B12 deficiency. BMJ Case Rep 2016 (online). https://doi.org/10.1136/bcr-2016-215728Google Scholar
Mishra, VA, Harbada, R, Sharma, A. Vitamin B12 and vitamin D deficiencies: an unusual cause of fever, severe hemolytic anemia and thrombocytopenia. J Fam Med Prim Care 2015;4:145148.Google Scholar
Carey, C, Clark, A, Saner, A. Excellent results with analgesic nitrous oxide for addictive withdrawal states in general practice. S Afr Med J 1991;79(8):516.Google Scholar
Cheng, HM, Park, JH, Hernstadt, D. Subacute combined degeneration of the spinal cord following recreational nitrous oxide use. BMJ Case Rep 2013;2013:bcr2012008509. https://doi.org/10.1136/ bcr-2012-008509Google Scholar
Randhawa, G, Bodenham, A. The increasing recreational use of nitrous oxide: history revisited. Br J Anaesthesia 2016;116(3):321324. https://doi.org/10.1093/bja/aev297Google Scholar
Cartner, M, Sinnott, M, Silburn, P. Paralysis caused by ‘nagging’. Med J Aust 2007;187:366367.Google Scholar
Sethi, NK, Mullin, P, Torgovnick, J, Capasso, G. Nitrous oxide ‘whippit’ abuse presenting with cobalamin responsive psychosis. J Med Toxicol 2006;2(2):7174.Google Scholar
Al-Sadawi, M, Hidalgo, C, Chinyere, A, Apoorva, J, Modupe, O, McFarlane, SI. Inhaled nitrous oxide ‘whip-its!’ causing subacute combined degeneration of spinal cord. Am J Med Case Rep 2018;6(12):237240. https://doi.org/10.12691/ajmcr-6-12-3Google Scholar
Massey, TH, Pickersgill, TT, Peal, KJ. Nitrous oxide misuse and Vitamin B12 deficiency. BMJ Case Rep 2016 (online). https://doi.org/10.1136/bcr-2016-215728Google Scholar
Miller, MA, Martinez, V, McCarthy, R, et al. Nitrous oxide ‘whippit’ abuse presenting as clinical B12 deficiency and ataxia. Am J Emerg Med 2004;22:124.Google Scholar
Butzkueven, H, King, JO. Nitrous oxide myelopathy in an abuser of whipped cream bulbs. J Clin Neurosci 2000;7(1):7375.Google Scholar
Cheng, HM, Park, JH, Hernstadt, D. Subacute combined degeneration of the spinal cord following recreational nitrous oxide use. BMJ Case Rep 2013;2013:bcr2012008509. https://doi.org/10.1136/ bcr-2012-008509Google Scholar
Miller, MA, Martinez, V, McCarthy, R, et al. Nitrous oxide ‘whippit’ abuse presenting as clinical B12 deficiency and ataxia. Am J Emerg Med 2004;22:124.Google Scholar
Richardson, PG. Peripheral neuropathy following nitrous oxide abuse. Emerg Med Australas 2010;22(1):8890.Google Scholar
Diamond, AL, Diamond, R, Freedman, SM, Thomas, FP. ‘Whippets’-induced cobalamin deficiency manifesting as cervical myelopathy. J Neuroimaging 2004;14(3):277280.Google Scholar
Probasco, JC, Felling, RJ, Carson, JT, Dorsey, ER, Niessen, TM. Teaching neuroimages: myelopathy due to B12 deficiency in long-term colchicine treatment and nitrous oxide misuse. Neurology 2011;77(9):e51. https://doi.org/10.1212/WNL.0b013e31822c910fGoogle Scholar
Ghobrial, GM, Dalyai, R, Flanders, AE, Harrop, J. Nitrous oxide myelopathy posing as spinal cord injury. J Neurosurg Spine 2012;16(5):489491. https://doi.org/10.3171/2012.2.SPINE11532Google Scholar
Lundin, MS, Cherian, J, Andrew, MN, et al. One month of nitrous oxide abuse causing acute vitamin B 12 deficiency with severe neuropsychiatric symptoms BMJ Case Rep 2019;12:bcr–2018–228001.Google Scholar
Diamond, AL, Diamond, R, Freedman, SM, Thomas, FP. ‘Whippets’-induced cobalamin deficiency manifesting as cervical myelopathy. J Neuroimaging 2004;14(3):277280.Google Scholar
Thompson, AG, Leite, MI, Lunn, MP, Bennett DLH. Whippits, nitrous oxide and the dangers of legal highs. Pract Neurol 2015;15:207209. https://doi.org/10.1136/practneurol-2014-001071Google Scholar
Keddie, S, Adams, A, Kelso, ARC, et al. No laughing matter: subacute degeneration of the spinal cord due to nitrous oxide inhalation J Neurol 2018;265:10891095. https://doi.org/10.1007/s00415-018-8801-3Google Scholar
Vasconcelos, OM, Poehm, EH, McCarter, RJ, Campbell, WW, Quezado, ZMN. Potential outcome factors in subacute combined degeneration: review of observational studies. J Gen Intern Med 2006;21:10631068.Google Scholar
Massey, TH, Pickersgill, TT, Peal, KJ. Nitrous oxide misuse and Vitamin B12 deficiency. BMJ Case Rep 2016 (online). https://doi.org/10.1136/bcr-2016-215728Google Scholar
Shoults, K. Case report: neurological complications of nitrous oxide abuse. B C Med J 2016;58(4):192194.Google Scholar
Vasconcelos, OM, Poehm, EH, McCarter, RJ, Campbell, WW, Quezado, ZMN. Potential outcome factors in subacute combined degeneration: review of observational studies. J Gen Intern Med 2006;21:10631068.Google Scholar
Keddie, S, Adams, A, Kelso, ARC, et al. No laughing matter: subacute degeneration of the spinal cord due to nitrous oxide inhalation. J Neurol 2018; 265:10891095. https://doi.org/10.1007/s00415-018-8801-3Google Scholar
Blair, C, Tremonti, C, Edwards, L, Haber, PS, Halmagyi, GM. Vitamin B12 supplementation futile for preventing demyelination in ongoing nitrous oxide misuse Med J Aust 2019;211(9):428https://doi.org/10.5694/mja2.50371Google Scholar
Stacy, C, DiRocco, A, Gould, R. Methionine in the treatment of nitrous oxide induced neuropathy and myeloneuroapthy. J Neurol 1992;239(7):401403.Google Scholar
Ives, R, Ghelani, P. Polydrug use (the use of drugs in combination): a brief review. Drugs Educ Prev Policy 2006;13(3):225232.Google Scholar
Mancke, F, Kaklauskaite, 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 Rehab 2016:7 155159.Google Scholar
Garakani, A, Jaffe, RJ, Savla, D, et al. Neurologic, psychiatric, and other medical manifestations of nitrous oxide abuse: a systematic review of the case literature. Am J Addict 2016;25:358369.Google Scholar
Garakani, A, Jaffe, RJ, Savla, D, et al. Neurologic, psychiatric, and other medical manifestations of nitrous oxide abuse: a systematic review of the case literature. Am J Addict 2016;25:358369.Google Scholar

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