TY - JOUR
T1 - Brain and body disconnect
T2 - A retrospective case series of subacute combined degeneration of the spinal cord from chronic nitrous oxide use in Perth, Western Australia
AU - Soderstrom, Jessamine
AU - Grigg, Jodie
AU - McWilliam, Owen
AU - Fatovich, Daniel
PY - 2024/9
Y1 - 2024/9
N2 - Background: Chronic nitrous oxide (N2O) use causes inactivation of vitamin B12, resulting in neurological and psychiatric symptoms. This case series presents all N2O-related presentations to the emergency department at Royal Perth Hospital between June 2019 and June 2021, alongside the costs of these admissions. Case Presentation: Twenty-two patients were identified; 68% (n = 15) were male. The median age was 22.4 years (interquartile range [IQR], 20–30). Median daily number of N2O bulbs inhaled was 150 (IQR, 64–300) with a median duration of use of 9 months (IQR, 3–12). Presentations included ataxia, paraesthesia and falls (n = 18), urinary retention (n = 3) and psychotic symptoms (n = 2). Fourteen patients had severe symptoms prompting a magnetic resonance imaging of brain and spine, confirming 12 cases of subacute combined degeneration of the spinal cord. All patients had IMI vitamin B12 therapy, while 14 had oral methionine therapy. The median length of admission was 4 days (IQR 1–23 days). The median cost of admission per day for patients where costs were accessible (n = 7) was $2061 (IQR, $1903-$2860). Discussion and Conclusions: A case series of symptomatic chronic N2O use with severe neurological sequelae and significant costs associated per admission. Triangulation of emergency department and Ecstasy and Related Drugs Reporting System data helped prompt a swift public health response, including mandatory warning labels, limits to transaction amounts and legislative changes to the Medicines and Poisons Act to make it illegal for sale if there is a suspicion that it will be abused.
AB - Background: Chronic nitrous oxide (N2O) use causes inactivation of vitamin B12, resulting in neurological and psychiatric symptoms. This case series presents all N2O-related presentations to the emergency department at Royal Perth Hospital between June 2019 and June 2021, alongside the costs of these admissions. Case Presentation: Twenty-two patients were identified; 68% (n = 15) were male. The median age was 22.4 years (interquartile range [IQR], 20–30). Median daily number of N2O bulbs inhaled was 150 (IQR, 64–300) with a median duration of use of 9 months (IQR, 3–12). Presentations included ataxia, paraesthesia and falls (n = 18), urinary retention (n = 3) and psychotic symptoms (n = 2). Fourteen patients had severe symptoms prompting a magnetic resonance imaging of brain and spine, confirming 12 cases of subacute combined degeneration of the spinal cord. All patients had IMI vitamin B12 therapy, while 14 had oral methionine therapy. The median length of admission was 4 days (IQR 1–23 days). The median cost of admission per day for patients where costs were accessible (n = 7) was $2061 (IQR, $1903-$2860). Discussion and Conclusions: A case series of symptomatic chronic N2O use with severe neurological sequelae and significant costs associated per admission. Triangulation of emergency department and Ecstasy and Related Drugs Reporting System data helped prompt a swift public health response, including mandatory warning labels, limits to transaction amounts and legislative changes to the Medicines and Poisons Act to make it illegal for sale if there is a suspicion that it will be abused.
KW - harm reduction
KW - inhalant abuse
KW - neurotoxicity
KW - nitrous oxide
KW - poisoning
UR - http://www.scopus.com/inward/record.url?scp=85192794444&partnerID=8YFLogxK
U2 - 10.1111/dar.13858
DO - 10.1111/dar.13858
M3 - Article
C2 - 38740512
AN - SCOPUS:85192794444
SN - 0959-5236
VL - 43
SP - 1636
EP - 1644
JO - Drug and Alcohol Review
JF - Drug and Alcohol Review
IS - 6
ER -