[Acute and chronic toxicities associated with the use and misuse of nitrous oxide: An update]

W Caré; L Dufayet; M A Piot; I Crassard; P Manceau; P Niclot; A Batisse; D Vodovar

doi:10.1016/j.revmed.2021.10.008

[Acute and chronic toxicities associated with the use and misuse of nitrous oxide: An update]

Rev Med Interne. 2022 Mar;43(3):170-177. doi: 10.1016/j.revmed.2021.10.008. Epub 2021 Dec 10.

[Article in French]

Authors

W Caré¹, L Dufayet², M A Piot³, I Crassard⁴, P Manceau⁵, P Niclot⁶, A Batisse⁷, D Vodovar⁸

Affiliations

¹ Centre antipoison de Paris - Fédération de toxicologie de l'AP-HP, Hôpital Lariboisière-Fernand-Widal (AP-HP), 75010 Paris, France; Service de médecine interne, Hôpital d'instruction des armées Bégin, 94160 Saint-Mandé, France; Inserm UMR S-1144, Faculté de pharmacie, 75006 Paris, France.
² Inserm UMR S-1144, Faculté de pharmacie, 75006 Paris, France; Urgences médico-judiciaires, Hôpital de l'Hôtel-Dieu (AP-HP), 75001 Paris, France; UFR de médecine, Université de Paris, 75006 Paris, France.
³ UFR de médecine, Université de Paris, 75006 Paris, France; Service de psychiatrie de l'enfant, de l'adolescent et du jeune adulte, Institut Mutualiste Montsouris, 75014 Paris, France; Centre de Recherche en Epidémiologie et Santé des Populations (CESP), UMR 1018, UVSQ, 94800 Villejuif, France.
⁴ Service de neurologie, Hôpital Lariboisière-Fernand-Widal (AP-HP), 75010 Paris, France; Agence régionale de santé Île-de-France, Direction de l'Offre de Soins, 93000 Saint-Denis, France.
⁵ Service de neurologie, Hôpital Avicenne (AP-HP), 93000 Bobigny, France.
⁶ Service de neurologie, Centre Hospitalier René-Dubos, 95300 Cergy-Pontoise, France.
⁷ Centre d'Évaluation et d'Information sur la Pharmacodépendance (CEIP) de Paris, Hôpital Lariboisière-Fernand-Widal (AP-HP), 75010 Paris, France.
⁸ Centre antipoison de Paris - Fédération de toxicologie de l'AP-HP, Hôpital Lariboisière-Fernand-Widal (AP-HP), 75010 Paris, France; Inserm UMR S-1144, Faculté de pharmacie, 75006 Paris, France; UFR de médecine, Université de Paris, 75006 Paris, France. Electronic address: dominique.vodovar@aphp.fr.

PMID: 34903366
DOI: 10.1016/j.revmed.2021.10.008

Abstract

Nitrous oxide (N₂O) is used since the eighteenth century as an anesthetic and analgesic but also for recreational use. If the labelled uses of N₂O and their modalities are nowadays perfectly framed, the misuse of N₂O takes very alarming proportions among teenagers and young adults. This misuse is the cause of acute (hypoxia, barotrauma, burns, neuropsychiatric disorders) and chronic complications if repeated (myeloneuropathy, anemia, thrombosis, inhalant use disorder). The main mechanism of the latter is mainly related to a functional deficit in vitamin B12 induced by N₂O. The management of acute complications is symptomatic. The management of chronic complications is based on vitamin B12 supplementation. The best biomarker of chronic N₂O exposure is the elevation of the plasmatic level of methylmalonic acid. In all cases of recreational misuses, addiction treatment is necessary to prevent complications or their worsening by providing information in order to stop consumption.

Keywords: Addiction; Misuse; Mésusage; N(2)O; N2O; Neuropathie; Neuropathy; Nitrous oxide; Protoxyde d’azote.

MeSH terms

Administration, Inhalation
Adolescent
Humans
Nitrous Oxide* / toxicity
Vitamin B 12
Vitamin B 12 Deficiency* / complications
Young Adult

Substances

Nitrous Oxide
Vitamin B 12