Giving b12 after nitrous oxide addiction
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Heavy inhalant abuse can result in a variety of side effects, including cardiac arrhythmias, hypoxia, metabolic acidosis, and neurologic deficits.
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Nitrpus patient was not tested for other causes of B12 deficiency, such as atrophic gastritis, given his excessive use of nitrous oxide and improvement after discontinuation of nitrous oxide. Our patient had both abused N2O and received it medically.
Her methylmalonic acid MMA levels however were elevated. It is a direct measurement of the average size of the red blood cells.
It is capable of inactivating vitamin B12, producing a relative B12 deficiency. A phone interview with the patient revealed complete resolution of the ataxia by week 3. Prompt evaluation and treatment can at times render complete recovery. She denied continued abuse of N2O. In the United States, while it is not illegal to own or purchase N2O, it is illegal to inhale or possess N2O with the intent of inhaling it [ 5 ].
It was first discovered in the late 18th century and used as a recreational drug [ 2 ], and is known to cause states of euphoria and analgesia [ 3 ]. Sincethere have been many published reports of both occupational and recreational exposure to N2O with subsequent toxicity [ 1 ]. Social history included social alcohol use, weekly marijuana use, tobacco abuse smoking one pack per day for the last addkction yearsand use of N2O inhalation at least twice nitros for approximately six months.
N2O, a colorless gas used as an anesthetic since the late 19th century because of its euphoric and analgesic qualities, is now used notrous a recreational drug and is available via the Internet and at clubs. Why on earth had I never been informed of this? The contents of the balloon can then be directly inhaled, giving an instant feeling of euphoria.
ificant use of this gas can lead to a relative B12 deficiency. In the weeks after discharge, she followed up with a primary care physician. N2O is generally considered a safe natural gas, but with cumulative and heavy doses there are potential side effects that must be understood. Laboratory measurement of methylmalonic acid levels as a test is very sensitive for B12 deficiency, but is not specific [ 6 ].
Nitrous oxide–induced vitamin b12 deficiency
Patients who have a B12 deficiency or lack the active form of B12 will almost always an elevated methylmalonic acid level [ 6 ]. It is a spinal cord and peripheral disease which is caused by inactivation of vitamin B12 by nitrous oxide. After administering daily B12 injections for 2 weeks and complete abstinence from N2O, her neurologic deficits niyrous nearly resolved.
Arch Surg Over time, vitamin B12 deficiency can lead to fatigue, anemia, and nerve damage. Neurologic exam was remarkable for decreased vibratory sensation in bilateral lower extremities, absence of distal proprioception, hyperreflexia, impaired coordination, rapid alternating movements, truncal ataxia, and a positive Romberg test.
Two case reports
I do not have the answers, but I do have the initiative to encourage you to become better informed on this correlation. Keywords Nitrous oxide; B12 deficiency; MRI; Neurology Introduction Nitrous oxide N2O is an inhaled colorless gas which has been commonly used as an anesthetic since the 19th century [ 1 ].
Other publications indicate that spinal cord degeneration associated with N2O abuse is usually found in those with underlying B12 deficiency [ 10 ]. Pema et. J Neurol Neurosci.
A review of the literature reveals that the level of B12 prior to N2O exposure can drastically affect the severity of N2O toxicity. Low MCV values are seen with anemia of chronic disease, thalassemias, and most commonly iron deficiency anemia [ 6 ].
The link between nitrous oxide uptake and vitamin b12 deficiency
However, it may be also induced by the recreational use of nitrous oxide N2Oan often forgotten and important link to B12 deficiency in young, healthy individuals. Although N2O toxicity is a recognized entity, it is the purpose of this case report to reinforce this fact and present a unique case of N2O toxicity. Also, there was a history of general anxiety disorder. Given the clinical scenario and lack of evidence for other causes it was determined that her MCV was likely elevated due to an underlying B12 deficiency due to B12 inactivation by N2O.
Of all inhalants, nitrous oxide is particularly toxic due to its conversion of the active monovalent form of vitamin B12 to its inactive bivalent form 3. He admitted to daily nitrous oxide abuse for months prior, reportedly inhaling over 30 whipped cream chargers every day. We present the case of a 28 year old female who had been abusing N2O regularly. Myeloneuropathy can present with numbing and tingling in hands and feet.
Clinicians should infer that insidious B12 deficiency can become overt when N2O is used both appropriately and inappropriately. Vitamin B12 deficiency is usually caused by a restrictive vegetarian diet, malnutrition, malabsorption syndromes, congenital disease, gastrectomy, or other gastrointestinal tract diseases. Blissful ignorance is not excusable, so I researched the topic on Google Scholar and found acter that my patient was indeed right! This is not a benign means to achieve a euphoric state but can cause severe nitrous oxide—induced B12 deficiency, which is presented in this case report.
We present a case of subacute combined degeneration of the spinal cord due to nitrous oxide—induced vitamin B12 deficiency.
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