Nitrous Oxide Abuse-Induced Vitamin B12 Deficiency and Neurological Injury

Abstract

Nitrous oxide (NO), often recognized as “laughing gas” in medicine, has seen a surge in recreational use among young people over the last decades. While its medical application is generally safe at controlled doses, its abuse has raised major concerns due to its potential toxicity. The most commonly reported sequelae are associated with subacute combined degeneration of the spinal cord, and most cases describe myeloneuropathy (spinal cord demyelination and peripheral nerve injury) as the most common manifestation. Other cases report a wider range of NO-induced toxicity that extends beyond myeloneuropathy and includes a variety of cognitive and psychiatric, dermatological, gastrointestinal, cardiovascular, and pulmonary disorders. This chapter provides an overview of the major neurological impairments associated with NO abuse, including myelopathy, peripheral neuropathy, cognitive and psychiatric conditions. The main objective is to create awareness regarding the major neuropsychiatric impairments. It also aims to help clinicians in recognizing and managing NO-related neurotoxicity effectively, guiding appropriate investigations and facilitating timely treatment strategies to mitigate the harmful effects of NO abuse.