@article{ref1,
title="Just "nanging" around - harmful nitrous oxide use. A retrospective case series and review of internet searches, social media posts and the coroner's database",
journal="Internal medicine journal",
year="2021",
author="Chiew Angela, L. and Raubenheimer Jacques, E. and Ingrid, Berling and Buckley Nicholas, A. and Therese, Becker and Betty, Chan and Jonathan, Brett",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="INTRODUCTION: The chronic recreational inhalation of nitrous oxide (N(2) O) &quot;nanging&quot;, 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. <br><br>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. <br><br>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. <br><br>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.<p /> <p>Language: en</p>",
language="en",
issn="1444-0903",
doi="10.1111/imj.15391",
url="http://dx.doi.org/10.1111/imj.15391"
}