Emergency Medical Minute10 Jan 2022

Podcast 745: Nitrous-Induced B12 Deficiency

Contributor: Alicia Oberle, MD

Educational Pearls:

Nitrous oxide (N2O) can cause a vitamin B12 deficiency in patients after regular use
N2O is used in procedural sedation but also as a popular recreational drug
N2O binds and inactivate B12 in the body, therefore decreasing usable supply
Lack of B12, which is essential for myelinating nerves, can lead to subacute combined degeneration of the spinal cord
Presentation may include paresthesias, ataxia, gait changes, or bilateral lower extremity motor weakness
B12 can be normal on labs, as the B12 is present but inactivated
Treatment is daily B12 injections and oral supplementation

References

Stockton L, Simonsen C, Seago S. Nitrous oxide-induced vitamin B12 deficiency. Proc (Bayl Univ Med Cent). 2017;30(2):171-172. doi:10.1080/08998280.2017.11929571

Samia AM, Nenow J, Price D. Subacute Combined Degeneration Secondary to Nitrous Oxide Abuse: Quantification of Use With Patient Follow-up. Cureus. 2020;12(10):e11041. Published 2020 Oct 19. doi:10.7759/cureus.11041

Edigin E, Ajiboye O, Nathani A. Nitrous Oxide-induced B12 Deficiency Presenting With Myeloneuropathy. Cureus. 2019;11(8):e5331. Published 2019 Aug 6. doi:10.7759/cureus.5331

*Image obtained from Wikimedia author Hansmuller and licensed under Creative Commons Attribution-Share Alike 4.0 International license.

Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD

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