Recreational use of nitrous oxide causes seizure, pneumothorax, pneumomediastinum, and pneumopericardium: nitrous oxide and its harm, a case report
Keywords:
Pneumothorax, pneumopericardium, recreational drug, nitrous oxide
Abstract
Nitrous oxide, commonly known as ‘laughing gas’, has become a popular recreational drug. Whippets, small canisters containing gas in pressurized form, can be easily obtained from a food store. However, inhaling nitrous oxide from these canisters, which contain a 100% concentration, can lead to hypoxia, resulting in seizures or even death. Inhalation of nitrous oxide rarely causes pneumothorax, pneumomediastinum, and pneumopericardium.
This case study highlights the potential dangers of recreational abuse of nitrous oxide.
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References
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23. Redmond J, Cruse B, Kiers L. Nitrous oxide-induced neurological disorders: an increasing public health concern. Intern Med J. 2022;52(5):740–4. doi: 10.1111/imj.15544
24. Oulkadi S, Peters B, Vliegen AS. Thromboembolic complications of recreational nitrous oxide (ab)use: a systematic review. J Thromb Thrombolysis. 2022;54(4):686–95. doi: 10.1007/s11239-022-02673-x
25. Pushpakumar S, Kundu S, Sen U. Endothelial dysfunction: the link between homocysteine and hydrogen sulfide. Curr Med Chem. 2014;21(32):3662–72. doi: 10.2174/0929867321666140706142335
26. Fu Y, Wang X, Kong W. Hyperhomocysteinaemia and vascular injury: advances in mechanisms and drug targets. Br J Pharmacol. 2018;175(8):1173–89. doi: 10.1111/bph.13988
27. Liu F, Du J, Nie M, Fu J, Sun J. 5,10-methylenetetrahydrofolate reductase C677T gene polymorphism and peripheral arterial disease: a meta-analysis. Vascular. 2021;29(6):913–19. doi: 10.1177/1708538120982698
28. Homocysteine and risk of ischemic heart disease and stroke: a meta-analysis. JAMA. 2002;288(16):2015–22. doi: 10.1001/jama.288.16.2015
29. Vollenbrock SE, Fokkema TM, Leijdekkers VJ, Vahl AC, Konings R, van Nieuwenhuizen RC. Nitrous oxide abuse associated with severe thromboembolic complications. Eur J Vasc Endovasc Surg. 2021;62(4):656–7. doi: 10.1016/j.ejvs.2021.05.041
2. Guttormsson Ulf GI. Lustgas bland unga 2022. Stockholm: Centralförbundet för alkohol- och narkotikaupplysning; 2022.
3. Emmanouil DE, Quock RM. Advances in understanding the actions of nitrous oxide. Anesth Prog. 2007;54(1):9–18. doi: 10.2344/0003-3006(2007)54[9:Aiutao]2.0.Co;2
4. Sanders RD, Weimann J, Maze M. Biologic effects of nitrous oxide: a mechanistic and toxicologic review. Anesthesiology. 2008;109(4):707–22. doi: 10.1097/ALN.0b013e3181870a17
5. Baum JA. The carrier gas in anaesthesia: nitrous oxide/oxygen, medical air/oxygen and pure oxygen. Curr Opin Anaesthesiol. 2004;17(6):513–16. doi: 10.1097/00001503-200412000-00012
6. Huang C, Johnson N. Nitrous oxide, from the operating room to the emergency department. Curr Emerg Hosp Med Rep. 2016;4:11–18. doi: 10.1007/s40138-016-0092-3
7. Babl FE, Oakley E, Seaman C, Barnett P, Sharwood LN. High-concentration nitrous oxide for procedural sedation in children: adverse events and depth of sedation. Pediatrics. 2008;121(3):e528–32. doi: 10.1542/peds.2007-1044
8. Kaar SJ, Ferris J, Waldron J, Devaney M, Ramsey J, Winstock AR. Up: the rise of nitrous oxide abuse. An international survey of contemporary nitrous oxide use. J Psychopharmacol. 2016;30(4):395–401. doi: 10.1177/0269881116632375
9. Bäckström B, Johansson B, Eriksson A. Death from nitrous oxide. J Forensic Sci. 2015;60(6):1662–5. doi: 10.1111/1556-4029.12879
10. Kaisti KK, Långsjö JW, Aalto S, Oikonen V, Sipilä H, Teräs M, et al. Effects of sevoflurane, propofol, and adjunct nitrous oxide on regional cerebral blood flow, oxygen consumption, and blood volume in humans. Anesthesiology. 2003;99(3):603–13. doi: 10.1097/00000542-200309000-00015
11. Myles PS, Leslie K, Silbert B, Paech MJ, Peyton P. A review of the risks and benefits of nitrous oxide in current anaesthetic practice. Anaesth Intens Care. 2004;32(2):165–72. doi: 10.1177/0310057x0403200202
12. Akca O, Lenhardt R, Fleischmann E, Treschan T, Greif R, Fleischhackl R, et al. Nitrous oxide increases the incidence of bowel distension in patients undergoing elective colon resection. Acta Anaesthesiol Scand. 2004;48(7):894–8. doi: 10.1111/j.0001-5172.2004.00427.x
13. Oomens T, Riezebos RK, Amoroso G, Kuipers RS. Case report of an acute myocardial infarction after high-dose recreational nitrous oxide use: a consequence of hyperhomocysteinaemia? Eur Heart J Case Rep. 2021;5(2):ytaa557. doi: 10.1093/ehjcr/ytaa557
14. McDermott R, Tsang K, Hamilton N, Belton M. Recreational nitrous oxide inhalation as a rare cause of spontaneous pneumomediastinum. BMJ Case Rep. 2015;2015:bcr2015209750. doi: 10.1136/bcr-2015-209750
15. Wagner SA, Clark MA, Wesche DL, Doedens DJ, Lloyd AW. Asphyxial deaths from the recreational use of nitrous oxide. J Forensic Sci. 1992;37(4):1008–15. doi: 10.1520/JFS13286J
16. Drug-related deaths involving nitrous oxide in England and Wales, 1993 to 2017. London: Office for National Statistic (ONS); 2018.
17. Quax MLJ, Van Der Steenhoven TJ, Antonius Bronkhorst MWG, Emmink BL. Frostbite injury: an unknown risk when using nitrous oxide as a party drug. Acta Chir Belg. 2022;122(2):140–3. doi: 10.1080/00015458.2020.1782160
18. Chen JHC, Eriksson S, Mohamed H, Bhatti S, Frew Q, Barnes D. Experiences of frostbite injury from recreational use of nitrous oxide canisters in a UK burns center: not a laughing matter. J Plast Reconstr Aesthet Surg. 2023;83:282–8. doi: 10.1016/j.bjps.2023.05.012
19. Rowson AC, Yii MX, Tan HB, Prasad J. Recreational nitrous oxide-induced injury to the soft palate. Clin Case Rep. 2023;11(9):e7858. doi: 10.1002/ccr3.7858
20. Chan SA, Alfonso KP, Comer BT. Upper aerodigestive tract frostbite from inhalation of automotive nitrous oxide. Ear Nose Throat J. 2018;97(9):E13–14. doi: 10.1177/014556131809700903
21. Buhre W, Disma N, Hendrickx J, DeHert S, Hollmann MW, Huhn R, et al. European Society of Anaesthesiology Task Force on Nitrous Oxide: a narrative review of its role in clinical practice. Br J Anaesth. 2019;122(5):587–604. doi: 10.1016/j.bja.2019.01.023
22. Xiang Y, Li L, Ma X, Li S, Xue Y, Yan P, et al. Recreational nitrous oxide abuse: prevalence, neurotoxicity, and treatment. Neurotox Res. 2021;39(3):975–85. doi: 10.1007/s12640-021-00352-y
23. Redmond J, Cruse B, Kiers L. Nitrous oxide-induced neurological disorders: an increasing public health concern. Intern Med J. 2022;52(5):740–4. doi: 10.1111/imj.15544
24. Oulkadi S, Peters B, Vliegen AS. Thromboembolic complications of recreational nitrous oxide (ab)use: a systematic review. J Thromb Thrombolysis. 2022;54(4):686–95. doi: 10.1007/s11239-022-02673-x
25. Pushpakumar S, Kundu S, Sen U. Endothelial dysfunction: the link between homocysteine and hydrogen sulfide. Curr Med Chem. 2014;21(32):3662–72. doi: 10.2174/0929867321666140706142335
26. Fu Y, Wang X, Kong W. Hyperhomocysteinaemia and vascular injury: advances in mechanisms and drug targets. Br J Pharmacol. 2018;175(8):1173–89. doi: 10.1111/bph.13988
27. Liu F, Du J, Nie M, Fu J, Sun J. 5,10-methylenetetrahydrofolate reductase C677T gene polymorphism and peripheral arterial disease: a meta-analysis. Vascular. 2021;29(6):913–19. doi: 10.1177/1708538120982698
28. Homocysteine and risk of ischemic heart disease and stroke: a meta-analysis. JAMA. 2002;288(16):2015–22. doi: 10.1001/jama.288.16.2015
29. Vollenbrock SE, Fokkema TM, Leijdekkers VJ, Vahl AC, Konings R, van Nieuwenhuizen RC. Nitrous oxide abuse associated with severe thromboembolic complications. Eur J Vasc Endovasc Surg. 2021;62(4):656–7. doi: 10.1016/j.ejvs.2021.05.041
Published
2023-12-08
How to Cite
Davidson L. T. (2023). Recreational use of nitrous oxide causes seizure, pneumothorax, pneumomediastinum, and pneumopericardium: nitrous oxide and its harm, a case report. Upsala Journal of Medical Sciences, 128(1). https://doi.org/10.48101/ujms.v128.10281
Section
Case Reports
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