Acute psychotic and vitamin B12 deficiency in patient with nitrous oxide misuse: A case report.

Chronic nitrous oxide misuse can cause psychiatric complications such as depression, hypomania, and paranoid psychosis with hallucinations. A 25-year-old woman with bizarre behavior, delusions, and hallucinations had low vitamin B12 levels (135 pmol/L) and a normal neurological exam. Treatment with antipsychotics and vitamin B12 resolved her psychosis. The case highlights that acute psychosis can occur in young people, with use ranging from one month to years, and clinicians need greater awareness of nitrous oxide misuse.

Study at a glance

Abstract

Nitrous oxide, also called nitrous monoxide, or nitrous oxide, is a colorless and odorless gas, without toxicological effect, but it can be asphyxiating at high concentration, its misuse is increasing especially among young people. Chronic use of N2O may cause psychiatric complications, including depression, hypomania, and paranoid psychosis with visual and auditory hallucinations. We present a case of nitrous oxide abuse "laughing gas" in 25 years old woman with bizarre behavior delusions and hallucinations with a normal neurological examination. The patient had low levels of vitamin B12 (135 pmol/L). Treatment with antipsychotics and vitamin B12 (cobalamin) resolved her psychosis. In addition to the hematological and neurological effects, rare cases of acute psychosis, especially in young people with or without psychiatric history, use varies from 1 month to years. Clinicians are increasingly in need of knowledge regarding the misuse of nitrous oxide.