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Citation
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Chiew Angela L, Raubenheimer Jacques E, Ingrid B, Buckley Nicholas A, Therese B, Betty C, Jonathan B. Intern. Med. J. 2021; ePub(ePub): ePub. |
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Abstract
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INTRODUCTION: The chronic recreational inhalation of nitrous oxide (N(2) O) "nanging", can have adverse neurological and psychiatric effects. This study evaluated cases of N(2) O abuse presenting to two hospitals, N(2) O-related deaths, and N(2) O-related internet and social media trends.
METHODS: Retrospective review of two toxicology units, from July 2017-Oct 2020, of patients presenting with chronic N(2) O use and neurological and/or psychiatric symptoms. We evaluated 10 y (2010-2019) of internet search and social media trends involving N(2) O, and the National Coronial Information System (NCIS) database for deaths across Australia.
RESULTS: Twenty-two patients were identified: median age 22 y, half female, 17 Asian background and 15 students. Presentations included decreased mobility or unsteady gait (n = 15) and psychiatric symptoms (n = 5). The median reported bulb use/day was 300 (IQR:200-370), for a median of 6 months (IQR:3-24). On MRI 10/18 had subacute combined degeneration of the spinal cord and 7/7 sensorimotor neuropathy on nerve conduction studies. All received high-dose intramuscular vitamin B(12) and 11 methionine. Despite prolonged rehabilitation, nine required walking aids on discharge. Since 2017 social media posts and internet searches for N(2) O increased rapidly, the latter mostly directed at obtaining N(2) O canisters. From the NCIS, 36 deaths were identified, 12 unintentional (recreational drug-use), 20 intentional self-harm and 4 traumatic.
CONCLUSION: We report a case series of symptomatic chronic N(2) O use, many with ongoing neurological sequelae. Furthermore, a sharp increase in internet searches to obtain N(2) O cannisters was noted. Education of high-risk student groups on the long-term sequalae is important. This article is protected by copyright. All rights reserved.
Language: en |