Severe Neutropenia and Vitamin B12 Deficiency in a Patient With Recreational Nitrous Oxide Use and History of Polysubstance Use: A Case Report.
Cureus August 1, 2025 Lindsay A Turmelle, Carl Chotas
Chronic recreational use of nitrous oxide can cause severe neurological and hematological toxicity, as shown in a case of a young adult who presented with abdominal pain, vomiting, confusion, radicular pain in the upper extremities, and later developed depressive symptoms, insomnia, and ataxia. Laboratory tests revealed severe neutropenia, pancytopenia, and vitamin B12 deficiency, confirming nitrous oxide-induced neurotoxicity. Treatment included stopping nitrous oxide use, vitamin B12 supplementation, psychiatric care, and supportive therapy, leading to gradual improvement. The case underscores the growing public health concern of nitrous oxide abuse, which can cause potentially irreversible neurological damage linked to vitamin B12 deficiency, and highlights the need for early recognition and preventive measures.