Is there a correlation between inhalant abuse (huffing) of nitrous oxide (NOS) and paresthesias?

From the Guidelines

There is a correlation between huffing nitrous oxide (NOS) and paresthesias, as recreational use of nitrous oxide can lead to vitamin B12 deficiency, causing neurological symptoms including paresthesias. The mechanism involves nitrous oxide oxidizing the cobalt ion in vitamin B12, rendering it inactive and unable to function as a cofactor for methionine synthase, an enzyme crucial for myelin formation and maintenance of the nervous system 1. Some key points to consider:

• Nitrous oxide is an inhalational agent co-administered with oxygen, with benefits including rapid onset, rapid recovery, and an excellent safety profile 1.
• However, its use can lead to hypoxia, hypertension, arrhythmias, nausea, vomiting, and headache 1.
• The major risk of nitrous oxide is hypoxia, which is avoided by coadministration with 30% to 50% oxygen 1.
• Treatment for nitrous oxide-induced paresthesias typically involves immediately stopping nitrous oxide use and high-dose vitamin B12 supplementation, often administered intramuscularly.
• Recovery depends on the extent of nerve damage and can take weeks to months, with some cases resulting in permanent neurological deficits if the condition is severe or treatment is delayed. It's worth noting that the provided studies do not directly address the correlation between huffing nitrous oxide and paresthesias, but they do provide information on the use of nitrous oxide as a sedative and its potential risks and side effects 1. However, based on the available evidence and general medical knowledge, it is clear that there is a correlation between huffing nitrous oxide and paresthesias, and that immediate cessation of nitrous oxide use and vitamin B12 supplementation are essential for treatment.

From the Research

Correlation between Huffing Nos and Paresthesias

• There is evidence to suggest a correlation between huffing nos (nitrous oxide) and paresthesias, as several studies have reported cases of patients developing paresthesias after recreational use of nitrous oxide 2, 3, 4, 5.
• Paresthesias are a common symptom of subacute combined degeneration (SCD), a neurologic complication caused by vitamin B12 deficiency, which can be induced by nitrous oxide abuse 4.
• Studies have shown that patients who abuse nitrous oxide often present with neurological symptoms, including paresthesias, ataxia, and muscle weakness, due to vitamin B12 deficiency 2, 3, 5.
• The use of nitrous oxide can lead to functional vitamin B12 deficiency, which can cause a range of neurological symptoms, including paresthesias 4.
• While some studies have reported cases of patients with psychiatric symptoms, including hallucinations and delusions, after nitrous oxide abuse, the relationship between nitrous oxide use and psychiatric symptoms is not fully understood 6.

Neurological Complications

• Nitrous oxide abuse can lead to neurological complications, including myelopathy, sensorimotor axonal polyneuropathy, and subacute combined degeneration (SCD) 2, 3, 5.
• These complications can cause a range of symptoms, including paresthesias, ataxia, muscle weakness, and sensory dysfunction 2, 3, 5.
• The diagnosis of neurological complications due to nitrous oxide abuse can be challenging, and treatment guidelines are often lacking 2.

Treatment and Outcome

• Treatment for neurological complications due to nitrous oxide abuse typically involves cessation of nitrous oxide use and supplementation with intramuscular injections of cobalamin (vitamin B12) 2, 3.
• The outcome for patients with neurological complications due to nitrous oxide abuse can vary, with some patients experiencing minimal improvement in the short term, but moderate to complete recovery in the long term 3.