Nitrous oxide toxicity - Revision history

Imogen: /* Background */

2025-08-16T04:22:42Z

Background

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	==Background==		==Background==
	*Nitrous oxide toxicity is often associated with inhalation of whipped cream or small nitrous oxide cannisters ([[whippets]])		*Nitrous oxide toxicity is often associated with inhalation of whipped cream or small nitrous oxide cannisters ([[whippets]])
	*~~Short~~-lived euphoric and calming effects through noncompetitive NMDA antagonism and GABA-A agonism.		*Commonly abused drug notable for its short-lived euphoric and calming effects through noncompetitive NMDA antagonism and GABA-A agonism.
	*Nitrous is much more soluble in blood and will quickly diffuse from the blood to a closed space.		*Nitrous is much more soluble in blood and will quickly diffuse from the blood to a closed space.
	*Beyond the gaseous effects nitrous oxide mainly disrupts B12 by oxidizing the cobalt ion which irreversibly inhibits methionine synthase<ref>Nunn J. Clinical aspects of the interaction between nitrous oxide and vitamin B12. British Journal of Anaesthesia. 1987; 59:3-13</ref>		*Beyond the gaseous effects nitrous oxide mainly disrupts B12 by oxidizing the cobalt ion which irreversibly inhibits methionine synthase<ref>Nunn J. Clinical aspects of the interaction between nitrous oxide and vitamin B12. British Journal of Anaesthesia. 1987; 59:3-13</ref>

Imogen: /* Evaluation */

2025-08-16T04:14:45Z

Evaluation

← Older revision		Revision as of 04:14, 16 August 2025
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	==Evaluation==		==Evaluation==
	*Nitrous oxide use is undetectable by standard drug screens, which makes obtaining a thorough history crucial.<ref>Agarwal P, et al. Recreational nitrous oxide-induced subacute combined degeneration of the spinal cord. Cureus. 2021;13(11):e19377. [https://pmc.ncbi.nlm.nih.gov/articles/PMC8653952/]</ref>		*Nitrous oxide use is undetectable by standard drug screens, which makes obtaining a thorough history crucial.<ref>Agarwal P, et al. Recreational nitrous oxide-induced subacute combined degeneration of the spinal cord. Cureus. 2021;13(11):e19377. [https://pmc.ncbi.nlm.nih.gov/articles/PMC8653952/]</ref>
	*~~If patient has history of regular nitrous use and presents with neuro~~ deficits ~~such as ataxia or neuromuscular weakness, recommend consultation with~~ poison control.		*Neuro deficits:
			**Consult poison control for recommendations.
			**May be exacerbated in cases of underlying [[B12 deficiency]].
	===Workup===		===Workup===

Imogen: /* Evaluation */

2025-08-16T03:30:57Z

Evaluation

← Older revision		Revision as of 03:30, 16 August 2025
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	==Evaluation==		==Evaluation==
	*Nitrous oxide use is undetectable by standard drug screens, which makes obtaining a thorough history crucial.<ref>Agarwal P, et al. Recreational nitrous oxide-induced subacute combined degeneration of the spinal cord. Cureus. 2021;13(11):e19377. [https://pmc.ncbi.nlm.nih.gov/articles/PMC8653952/]</ref>		*Nitrous oxide use is undetectable by standard drug screens, which makes obtaining a thorough history crucial.<ref>Agarwal P, et al. Recreational nitrous oxide-induced subacute combined degeneration of the spinal cord. Cureus. 2021;13(11):e19377. [https://pmc.ncbi.nlm.nih.gov/articles/PMC8653952/]</ref>
	*If patient has history of regular nitrous use and neuro deficits such as ataxia or neuromuscular weakness ~~are present~~, recommend consultation with poison control.		*If patient has history of regular nitrous use and presents with neuro deficits such as ataxia or neuromuscular weakness, recommend consultation with poison control.
	===Workup===		===Workup===

Imogen: /* Evaluation */ typo

2025-08-16T03:29:47Z

Evaluation: typo

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	==Evaluation==		==Evaluation==
	*Nitrous oxide use is undetectable by standard drug screens, which makes obtaining a ~~through~~ history crucial.<ref>Agarwal P, et al. Recreational nitrous oxide-induced subacute combined degeneration of the spinal cord. Cureus. 2021;13(11):e19377. [https://pmc.ncbi.nlm.nih.gov/articles/PMC8653952/]</ref>		*Nitrous oxide use is undetectable by standard drug screens, which makes obtaining a thorough history crucial.<ref>Agarwal P, et al. Recreational nitrous oxide-induced subacute combined degeneration of the spinal cord. Cureus. 2021;13(11):e19377. [https://pmc.ncbi.nlm.nih.gov/articles/PMC8653952/]</ref>
	*If patient has history of regular nitrous use and neuro deficits such as ataxia or neuromuscular weakness are present, recommend consultation with poison control.		*If patient has history of regular nitrous use and neuro deficits such as ataxia or neuromuscular weakness are present, recommend consultation with poison control.
	===Workup===		===Workup===

Imogen: /* Evaluation */ poison control recommendation

2025-08-16T03:28:41Z

Evaluation: poison control recommendation

← Older revision		Revision as of 03:28, 16 August 2025
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	==Evaluation==		==Evaluation==
	*Nitrous oxide use is undetectable by standard drug screens, which makes obtaining a through history crucial.<ref>Agarwal P, et al. Recreational nitrous oxide-induced subacute combined degeneration of the spinal cord. Cureus. 2021;13(11):e19377. [https://pmc.ncbi.nlm.nih.gov/articles/PMC8653952/]</ref>		*Nitrous oxide use is undetectable by standard drug screens, which makes obtaining a through history crucial.<ref>Agarwal P, et al. Recreational nitrous oxide-induced subacute combined degeneration of the spinal cord. Cureus. 2021;13(11):e19377. [https://pmc.ncbi.nlm.nih.gov/articles/PMC8653952/]</ref>
			*If patient has history of regular nitrous use and neuro deficits such as ataxia or neuromuscular weakness are present, recommend consultation with poison control.
	===Workup===		===Workup===

Imogen: /* Chronic complications */ subacute combined degeneration

2025-08-16T03:16:10Z

Chronic complications: subacute combined degeneration

← Older revision		Revision as of 03:16, 16 August 2025
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	**[[Thrombocytopenia]]		**[[Thrombocytopenia]]
	*Peripheral neuropathy		*Peripheral neuropathy
			*Subacute combined degeneration of the spinal cord

	==Evaluation==		==Evaluation==

Imogen: /* Background */ receptors

2025-08-16T03:10:45Z

Background: receptors

← Older revision		Revision as of 03:10, 16 August 2025
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	==Background==		==Background==
	*Nitrous oxide toxicity is often associated with inhalation of whipped cream or small nitrous oxide cannisters ([[whippets]])		*Nitrous oxide toxicity is often associated with inhalation of whipped cream or small nitrous oxide cannisters ([[whippets]])
	*Nitrous is much more soluble in blood and will quickly diffuse from the blood to a closed space		*Short-lived euphoric and calming effects through noncompetitive NMDA antagonism and GABA-A agonism.
			*Nitrous is much more soluble in blood and will quickly diffuse from the blood to a closed space.
	*Beyond the gaseous effects nitrous oxide mainly disrupts B12 by oxidizing the cobalt ion which irreversibly inhibits methionine synthase<ref>Nunn J. Clinical aspects of the interaction between nitrous oxide and vitamin B12. British Journal of Anaesthesia. 1987; 59:3-13</ref>		*Beyond the gaseous effects nitrous oxide mainly disrupts B12 by oxidizing the cobalt ion which irreversibly inhibits methionine synthase<ref>Nunn J. Clinical aspects of the interaction between nitrous oxide and vitamin B12. British Journal of Anaesthesia. 1987; 59:3-13</ref>
	*Epidemiology		*Epidemiology

Imogen: /* Chronic complications */ neuropathy

2025-08-14T04:04:15Z

Chronic complications: neuropathy

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	**[[Megaloblastic anemia]]		**[[Megaloblastic anemia]]
	**[[Thrombocytopenia]]		**[[Thrombocytopenia]]
			*Peripheral neuropathy

	==Evaluation==		==Evaluation==

Imogen: /* Background */

2025-08-14T03:51:17Z

Background

← Older revision		Revision as of 03:51, 14 August 2025
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	**Rates of nitrous oxide misuse vary significantly by country and are generally higher in Europe and the United States.		**Rates of nitrous oxide misuse vary significantly by country and are generally higher in Europe and the United States.
	**The World Drug Report found nitrous oxide use (i.e. at least once in last 12 months) in 16-24 year olds doubled globally between 2015 to 2021, from 10% to 20%.<ref>United Nations Office on Drugs and Crime. World Drug Report 2021. 2021. [https://www.unodc.org/unodc/en/data-and-analysis/wdr2021.html]</ref>		**The World Drug Report found nitrous oxide use (i.e. at least once in last 12 months) in 16-24 year olds doubled globally between 2015 to 2021, from 10% to 20%.<ref>United Nations Office on Drugs and Crime. World Drug Report 2021. 2021. [https://www.unodc.org/unodc/en/data-and-analysis/wdr2021.html]</ref>
	*Most nitrous oxide misuse is sporadic and without health consequences. This and its ease of availability may lead users to erroneously view it as ~~risk-free~~.		*Most nitrous oxide misuse is sporadic and without significant health consequences. This and its ease of availability may lead users to erroneously view it as safe.
	*Nitrous oxide use is undetectable by standard drug screens, making it crucial to obtain a thorough history.<ref>Agarwal P, et al. Recreational nitrous oxide-induced subacute combined degeneration of the spinal cord. Cureus. 2021;13(11):e19377. [https://pmc.ncbi.nlm.nih.gov/articles/PMC8653952/]</ref>

	==Clinical Features==		==Clinical Features==

Imogen: /* Evaluation */ move drug screen discussion from background

2025-08-14T03:49:55Z

Evaluation: move drug screen discussion from background

← Older revision		Revision as of 03:49, 14 August 2025
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	==Evaluation==		==Evaluation==
			*Nitrous oxide use is undetectable by standard drug screens, which makes obtaining a through history crucial.<ref>Agarwal P, et al. Recreational nitrous oxide-induced subacute combined degeneration of the spinal cord. Cureus. 2021;13(11):e19377. [https://pmc.ncbi.nlm.nih.gov/articles/PMC8653952/]</ref>
	===Workup===		===Workup===