Ballooning risks: thromboembolic events associated with nitrous oxide misuse

Document Type

Conference Proceeding

Publication Date

5-7-2025

Publication Title

Clin Toxicol

Keywords

Toxicology

Abstract

Objective: Recreational misuse of nitrous oxide (N2O) has risen significantly and can result in neurological impairment. Thromboembolic complications are less widely reported [1]. We sought to characterize thromboembolic effects associated with N2O misuse managed by our consult service. Case series: A retrospective review of 10 patients presenting following recreational N2O misuse at a single academic hospital managed by a medical toxicology service. The median age was 29.5 years. Thromboembolic events were identified in five patients and included: cardiac arrest with coronary artery occlusion (2), cerebrovascular accident with large vessel occlusion (2), peripheral deep venous thrombosis (2), and pulmonary embolism (1). Neurological deficits occurred in 6 of 10 cases (60%) and in 3 of 5 (60%) thromboembolic cases. Both thromboembolic and non-thromboembolic groups exhibited elevated markers of vitamin B572 inhibition (Table 1). Conclusion: Our data underscores the association between chronic N2O misuse and thromboembolic events. Elevated homocysteine and methylmalonic acid concentrations were seen in symptomatic patients. These events may be mediated by N2O’s inhibition of vitamin B572 and methionine synthase, leading to elevated homocysteine, a cardiovascular risk factor, and methylmalonic acid, a cause of oxidative stress. It remains unclear which users are most at risk or if asymptomatic users have elevated markers of B572 inhibition. Clinicians should consider N2O toxicity in young patients with thromboembolic episodes of unknown etiology.

Volume

63

First Page

42

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