Nitrous Oxide–Induced Vitamin B12 Deficiency With Delayed Neuropathy Diagnosis
Study at a glance
AI-extracted from the abstract| Characteristics | Case study Case report |
|---|---|
| Sample size | 1 |
| Population | A 32-year-old female with polysubstance use disorder and chronic nitrous oxide use |
| Interventions | Parenteral vitamin B12 replacement rehabilitation |
| Key findings | The authors report that chronic nitrous oxide use caused severe vitamin B12 deficiency in a 32-year-old woman, producing paresthesia, gait instability, and lower extremity paralysis that was initially misdiagnosed because MRI and cerebrospinal fluid analysis were non-diagnostic. They argue that clinicians should consider nitrous oxide-related B12 deficiency in unexplained neurologic symptoms and assess substance use to prevent irreversible injury. |
Abstract
A 32-year-old female with polysubstance use disorder presented with progressive neurologic symptoms, including paresthesia, gait instability, and eventual lower extremity paralysis. Initial evaluation, including magnetic resonance imaging and cerebrospinal fluid analysis, was non-diagnostic, contributing to delayed diagnosis. Subsequent laboratory testing revealed severe vitamin B12 deficiency secondary to chronic nitrous oxide use. The patient required hospitalization, parenteral vitamin B12 replacement, and rehabilitation. This case highlights an underrecognized cause of neurologic dysfunction and emphasizes the importance of comprehensive substance use assessment, targeted metabolic evaluation, and early recognition in patients with unexplained neurologic symptoms to prevent irreversible neurologic injury and long-term disability. 1-4