Nitrous oxide "whippit" abuse presenting with cobalamin responsive psychosis.
Nitin K Sethi, Paul Mullin, Josh Torgovnick, Giuseppe Capasso
Journal of medical toxicology : official journal of the American College of Medical Toxicology June 2006 DOI: 10.1007/bf03161175 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case study Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | A 33-year-old male with nitrous oxide abuse and psychosis |
| Intervention | Intramuscular cobalamin |
| Key findings | A 33-year-old man with nitrous oxide abuse and psychosis had low-normal vitamin B12 but markedly elevated methylmalonyl CoA and homocysteine; intramuscular cobalamin resolved his psychosis, highlighting the need to consider functional B12 deficiency in such patients. |
Abstract
Nitrous oxide is a commonly abused inhalant drug. It is known to precipitate vitamin B12 deficiency when used chronically and acutely, especially in people having marginal vitamin B12 reserve. We are presenting a case of nitrous oxide "whippit" abuse in a thirty-three-year-old male with bizarre behavior and delusions. The patient had low normal levels of vitamin B12 (202 pg/ml), but he had markedly high methylmalonyl CoA (1078 nmol/L) and homocysteine (48.4 mcmol/L). Treatment with intramuscular cobalamin led to a resolution of his psychosis. This case report highlights the need to consider vitamin B12 deficiency in patients who arrive at a hospital with psychiatric manifestations and who report having a history of nitrous oxide exposure or abuse in the recent or remote past. A review of the literature on the neuropsychological manifestations of vitamin B12 deficiency is provided.