Like our patient, most patients in these cases have subclinical B12 deficiency and symptoms that only develop after 1 to 6 months of heavy use. They typically consume nitrous oxide by puncturing the ends of commercially available cartridges or whipped cream canisters and breathing in the escaping gas or collecting it in a balloon and inhaling it from there. Patients in various case reports describe using 1 to 20 cartridges a day. Given that nitrous oxide is easy to acquire and believed by many to be harmless, the number of nitrous oxide abusers could increase in years to come.
Health care workers with chronic exposure to nitrous oxide, including dentists and anesthesiologists, have also been identified as being at increased risk for misuse, abuse, and dependence on nitrous oxide. Abstinence is key in treatment. Our patient did not abstain from use and perceived no improvement in her symptoms with B12 supplementation alone.
In the majority of cases, patients improve with abstinence and B12 supplementation, although symptoms can be slow to resolve and patients are not always deficit-free at the end of treatment. Serum B12 level does not seem to correlate with treatment response. Physicians should be aware that patients may fail to mention nitrous oxide when asked about drug use, and many seek medical attention a few times before a diagnosis of neuropathy related to abuse of nitrous oxide is made.
Summary The case of a year-old female shows how nitrous oxide abuse can cause subacute combined degenerative neuropathy secondary to B12 inactivation. The case also shows that nitrous oxide is easy to acquire and abuse of it is increasingly common.
This is unfortunate because recovery is slow and long-term deficits can result. Patients presenting with limb paresthesia, sensory loss, B12 deficiency, and other clinical findings described here should be asked about nitrogen oxide use.
Severe myeloneuropathy from acute high-dose nitrous oxide N2O abuse. J Emerg Med ; Postoperative myeloneuropathy: A preventable complication in patients with B12 deficiency. J Neuro-surg ; Reversible nitrous oxide-induced myeloneuropathy with pernicious anemia: Case report and literature review. Muscle Nerve ; Nitrous oxide for the management of labor pain: A systematic review. In any event, talk to your dentist if you develop any unusual symptoms after receiving nitrous oxide or if a side effect continues for hours or days after a procedure.
Based on your medical history, your doctor can determine whether this is an appropriate sedation method for you. While there are no known long-term side effects, misusing nitrous oxide or long-term exposure to the gas in a work environment may cause long-term complications. Toxic exposure may lead to a vitamin B deficiency or anemia. A severe vitamin B deficiency can cause nerve damage, resulting in tingling or numbness in your fingers, toes, and limbs.
Nitrous oxide is also a safe drug for toddlers and children. Similar to adults, children and toddlers who receive nitrous oxide may experience short-term side effects, such as:. Your child may also appear a little disoriented and irritable after receiving the gas. This can occur due to long-term exposure or from receiving too much of the gas.
An increase in blood pressure may also occur. This can raise the risk of a stroke or heart attack. Brain damage is also a possibility when a person receives a large dose of nitrous oxide without sufficient oxygen. If left untreated, an overdose can cause coma or death. Yet, side effects can occur after use.
But in the case of overuse or misuse, nitrous oxide can be dangerous and life-threatening. Since you are diabetic, there is no help available for you. This very incorrect but common statement is so unfortunate and untrue. Although the condition of diabetes does indeed complicate the condition of neuropathy, it does not eliminate the diabetic patient from significant help with their neuropathy condition.
This is what we have experienced by teaching diabetic individuals how to increase circulation and regenerate the health of their sensory nerves in the legs, feet, and hands. Please do not fail yourself with prejudice, doubt, indecision, or lack of action. Recovery is waiting for you, but you alone must take the responsibility and fulfill the simple, easy to learn steps which lead to dramatic improvement of this frustrating condition.
For more information on how you can began taking charge of your neuropathy condition as soon as today, I invite you to review the special, highly effective resolution program I created uniquely for peripheral neuropathy sufferers.
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Randall C. The program is presented in six simple steps which anyone can easily do. Each step is explained in plain English and illustrated in clear, step-by-step detail. By employing these steps the neuropathy sufferer will enhance the health of their peripheral sensory nerves and the surrounding environment, thereby reducing the pain, numbness, tingling, and other symptoms characteristic of the condition.
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Nitric oxide NO participates in critical actions involving several aspects of peripheral nerve function and disease. It offers important roles in "normal" afferent signaling of pain through the dorsal horn of the spinal cord and in autonomic control through nitrergic innervation.
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