Nitrous Oxide-Induced Pancytopenia and Peripheral Neuropathy From Chronic Whip-It™ Use: A Case Report
S. Pierce, Sarah Gergis, Sophia Dragan, Sai Sushrutha Mudupula Vemula, B. Hrinczenko
Cureus July 1, 2026 DOI: 10.7759/cureus.112883 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case study Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | 19-year-old female with no significant past medical history who used Whip-it!™ nitrous oxide daily for three months |
| Interventions | Vitamin B12 supplementation blood transfusions |
| Duration | Three months of daily Whip-it™ use before presentation |
| Key findings | A 19-year-old woman who used Whip-it!™ nitrous oxide daily for three months presented unresponsive with pancytopenia and severe vitamin B12 deficiency, along with weakness and tingling in all extremities, and improved significantly after vitamin B12 supplementation and blood transfusions. The authors argue that nitrous oxide inactivates vitamin B12 through irreversible oxidation of its cobalt atom and can cause deficiency within days or weeks, and they recommend that clinicians consider recreational nitrous oxide use in young patients with cytopenias and neurologic symptoms. |
Abstract
Nitrous oxide (N2O) is a colorless, odorless gas gaining popularity among recreational drug users for its euphoric effects. Whip-it!™ is a low-cost, freely available form of N2O commonly abused in parties and nightclubs. Chronic N2O use can inactivate vitamin B12, causing severe deficiency, anemia, neuropathy, and myelopathy. Here, we report a 19-year-old female with no significant past medical history who was found unresponsive in her apartment. She admitted to daily Whip-it™ use over the preceding three months. In the emergency department, she reported generalized weakness and tingling in all extremities. Workup revealed pancytopenia and profound vitamin B12 deficiency. She was treated with vitamin B12 supplementation and blood transfusions, with significant symptom improvement by discharge. N2O inactivates vitamin B12 through irreversible oxidation of the cobalt atom, causing deficiency and neurologic injury. Unlike other classic causes of vitamin deficiency, such as a vegan diet or pernicious anemia, N2O-induced anemia can occur very rapidly (within days or weeks). Clinicians should consider recreational N2O use in young patients presenting with cytopenias and neurologic symptoms. Given its easy availability and rising misuse, public health education to raise awareness is needed.