July 2021

This is a list of the latest papers we are aware of this month relating to the inhalation of gases and solvents. For information specifically on harms relating to butane, please click here.

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A rise in cases of nitrous oxide abuse: neurological complications and biological findings

"We report an elevated incidence of neurological complications of nitrous oxide abuse occurring during the recent COVID-19 lockdown. Nitrous oxide abuse should be tracked down in patients presenting with compatible neurological symptoms and elevated homocysteinemia. Vitamin B-12 should be supplemented as soon as the diagnosis is made."

Einsiedler, M., Voulleminot, P., Demuth, S. et al. (2021). A rise in cases of nitrous oxide abuse: neurological complications and biological findings. J Neurol. DOI: 10.1007/s00415-021-10702-7.

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How Not to Miss Nitrous Oxide Misuse During the Pandemic

"An otherwise healthy young person who presents with ascending weakness and paresthesias with ataxia should certainly be asked about possible exposure to nitrous oxide."

Gussow, L. (2021). How Not to Miss Nitrous Oxide Misuse During the Pandemic. Emergency Medicine News: July 2021 - Volume 43 - Issue 7 - p 15. DOI: 10.1097/01.EEM.0000758816.59762.53.

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Is Nitrous Oxide a Psychedelic Drug?

"Nitrous oxide (N2O) is both commonly used in medicine and recreationally. There are some similarities between the intoxicating effects of N2O and psychedelics, but ultimately they are very different in their mechanism of action and drug classification. These differences make nitrous oxide non-psychedelic."

Jaster, A.M., (2021). Is Nitrous Oxide a Psychedelic Drug? Psychedelic Science Review.

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Important reminder: nitrous oxide (N2O) as a cause of functional vitamin B12 deficiency

"A 32-year-old woman who misused multiple substances, including nitrous oxide (N2O), sought medical advice after she subacutely developed bilateral lower extremity weakness without a sensory level but with ataxia—her significant other developed similar symptoms with vitamin B12 deficiency due to N2O intake. Laboratory results revealed macrocytic anaemia despite normal B12 and folate levels, with serum markers pointing towards functional cobalamin deficiency. Spinal MRIs and cerebrospinal fluid analysis were unremarkable. Our patient was treated with vitamin B12 supplementation with an encouraging response."

Mahgoub, A.E., Deliwala, S.S., Bachuwa, G. (2021). Important reminder: nitrous oxide (N2O) as a cause of functional vitamin B12 deficiency. BMJ Case Reports CP 2021;14:e241414.

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No Laughing Matter: A Case of Diffuse Alveolar Damage in a Young Nitrous Oxide User

"Based on the patient’s clinical history, CT findings and blood test results, it was concluded that this was a case of diffuse alveolar injury from nitrous oxide inhalation ... The patient’s clinical history of nitrous oxide inhalation, the rapid progression to acute respiratory distress syndrome (ARDS) as well as the absence of any putative organisms cultured at bronchoalveolar lavage also support this conclusion. Her significant hypoxaemia and respiratory failure on admission was thought to be at least partly a result of nitrous oxide induced diffusion hypoxaemia and respiratory depression."

Thakkar, H., Morgan, L (2021). No Laughing Matter: A Case of Diffuse Alveolar Damage in a Young Nitrous Oxide User. Arch Clin Med Case Rep 2021; 5(3): 514-519. DOI: 10.26502/acmcr.96550386.

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Arytenoid swelling due to inhalation frostbite injury after the recreational use of nitrous oxide 

"In this case report, we present a patient with a potentially life-threatening airway obstruction after the recreational use of nitrous oxide"

Bagerman, R.A., Kriele, H.G.M., Peters, R. (2021). Arytenoid swelling due to inhalation frostbite injury after the recreational use of nitrous oxide. Netherlands Journal of Critical Care, 29(4), pp 185-187.

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Subacute Combined Degeneration Caused by Nitrous Oxide Abuse Mimicking Guillain-Barre Syndrome

"Here we present a case of SCD secondary to vitamin B12 deficiency due to nitrous oxide abuse."

Al Omari, O., Ahmed, A., Patel, D., Jani, C., Singh, H., Sasson, P., AbdelRazek, M. (2021). Subacute Combined Degeneration Caused by Nitrous Oxide Abuse Mimicking Guillain-Barre Syndrome. American Journal of Therapeutics. doi: 10.1097/MJT.0000000000001408

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Recreational use of nitrous oxide may cause collateral neurological damage

Sluyts, Y., Pals, P., Amir, R. et al. (2021). Recreational use of nitrous oxide may cause collateral neurological damage. Acta Neurol Belg. DOI: 10.1007/s13760-021-01740-z

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Inhalant Abuse of Ethyl Chloride Spray: A Case Report

"Ethyl chloride spray, which is usually used to relieve pain after injuries, is increasingly being used as a sniffing alternative. The number of people using this is rising due to its easy availability, cost-effectiveness and legality."

Hager, L., Kamp, F., Proebstl, L., Behle, N., Pogarell, O., Koller, G. (2021). Inhalant Abuse of Ethyl Chloride Spray: A Case Report. Fortschr Neurol Psychiatr: 89(07/08): 382-384. DOI: 10.1055/a-1483-9865

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Beta-Blockers for Inhalant-Induced Ventricular Dysrhythmias

"There are a few unique scenarios when beta-blockers may be indicated for patients in cardiac arrest. Use of esmolol for refractory ventricular fibrillation was summarized in a 2016 PharmERToxGuy post with an accompanying infographic. Another potential use for beta-blockers is in the rare case of a patient with inhalant-induced ventricular dysrhythmias. The term ‘sudden sniffing death’ refers to acute cardiotoxicity associated with inhaling hydrocarbons." 

Hayes, B.D. (2021). Beta-Blockers for Inhalant-Induced Ventricular Dysrhythmias. Academic Life in Emergency Medicine.

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AOSLO imaging in poppers maculopathy shows high resolution loss of central macular cones

"Poppers maculopathy is a rare, but visually significant, complication of popper abuse. AOSLO technology demonstrates significant cone damage in poppers maculopathy."

Rojas, C.N., Fawzi, A.A., Gill, M.K. (2021). AOSLO imaging in poppers maculopathy shows high resolution loss of central macular cones. American Journal of Ophthalmology Case Reports, 23. doi.org/10.1016/j.ajoc.2021.101166.