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Neurologic, psychiatric, and other medical manifestations of nitrous oxide abuse: A systematic review of the case literature
Author(s) -
Garakani Amir,
Jaffe Robert J.,
Savla Dipal,
Welch Alison K.,
Protin Caroline A.,
Bryson Ethan O.,
McDowell David M.
Publication year - 2016
Publication title -
the american journal on addictions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.997
H-Index - 76
eISSN - 1521-0391
pISSN - 1055-0496
DOI - 10.1111/ajad.12372
Subject(s) - medicine , psychiatry , psycinfo , medline , political science , law
Background/Objectives Nitrous oxide (N 2 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 N 2 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 N 2 O were excluded as were commentaries or personal essays. Clinical presentation, frequency of N 2 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 N 2 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 N 2 O abuse was correlated with low or low‐normal Vitamin B 12 (cyanocobalamin) levels ( N = 52) and occasionally elevated homocysteine and methylmalonic acid. Conclusions/Scientific Significance N 2 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 N 2 O and be able to identify potential N 2 O abuse. (Am J Addict 2016;25:358–369)