Severe Neutropenia and Vitamin B12 Deficiency in a Patient With Recreational Nitrous Oxide Use and History of Polysubstance Use: A Case Report.

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.

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Abstract

Nitrous oxide, commonly known as "laughing gas," has been widely used as a medical and dental sedative for centuries. Despite its recognized therapeutic applications, there has been a concerning rise in its recreational use, particularly among young adults. This trend has led to an increase in associated toxicities, including neurological, hematological, and psychiatric complications. This is a case report of a young adult presenting with neurological and hematological symptoms following chronic recreational nitrous oxide use. The patient exhibited diffuse abdominal pain, vomiting, nausea, confusion, and radicular pain in her upper extremities upon initial exam, which prompted an extensive diagnostic evaluation. These findings evolved during her hospital course, including the development of depressive symptoms, insomnia, and ataxia. Laboratory findings revealed evidence of severe neutropenia, pancytopenia, and vitamin B12 deficiency, supporting a diagnosis of nitrous oxide-induced neurotoxicity. Management included cessation of nitrous oxide exposure, vitamin B12 supplementation, psychiatric intervention, and supportive therapy, leading to gradual symptom improvement, which will hopefully continue in the outpatient setting. This case highlights the growing public health concern surrounding nitrous oxide abuse. Its recreational use can result in severe and potentially irreversible neurological impairment, often linked to its association with vitamin B12 deficiency. Increased awareness among healthcare providers is crucial for early recognition and intervention. Additionally, preventive measures, including public education and regulatory policies, may help curb the rising trend of nitrous oxide abuse. It is an emerging public health issue with significant consequences, and this case highlights the importance of early diagnosis and treatment, as well as the need for increased awareness to mitigate long-term complications.