Nadal Bosch Jorge, Malcolm Javier, Moya Mario, Menowsky Michael, Cruz Roberto A
Internal Medicine, Doctors Hospital at Renaissance/University of Texas Rio Grande Valley, Edinburg, USA.
Medical Information, Doctors Hospital at Renaissance, Edinburg, USA.
Cureus. 2023 Feb 1;15(2):e34514. doi: 10.7759/cureus.34514. eCollection 2023 Feb.
Nitrous oxide, also known as "laughing gas," is a naturally occurring gas that is colorless, odorless, nonflammable, and nontoxic. It has been used as an inhalant anesthetic in the medical field for more than 150 years for dental and surgical procedures. Due to its wide availability and ability to cause euphoria, its recreational use is on the rise. We present a case of subacute combined degeneration (SCD) due to nitrous oxide-induced vitamin B12 deficiency. The patient presented with bilateral lower extremity paresthesia, weakness, and ataxic gait. The patient was found to have vitamin B12 deficiency. An MRI of the cervical spine revealed an abnormal T2 signal within the cervical spinal cord extending from the level of C2-C6 affecting only the posterior column. On the fifth day of hospitalization, the patient reported that he had been inhaling nitric oxide from whipped cream cans for recreational use. According to his clinical presentation and laboratory and imaging findings, we concluded that the patient had SCD. The patient slowly improved after receiving vitamin B12 supplementation therapy. Patients presenting with paresthesia, weakness, and laboratory studies indicating vitamin B12 deficiency should be questioned about nitrous oxide recreational use since the incidence is increasing.
一氧化二氮，也被称为“笑气”，是一种天然存在的气体，无色、无味、不可燃且无毒。在医学领域，它作为吸入性麻醉剂已被用于牙科和外科手术超过150年。由于其广泛可得且能引起欣快感，其娱乐性使用正在增加。我们报告一例因一氧化二氮导致维生素B12缺乏引起的亚急性联合变性（SCD）病例。患者表现为双侧下肢感觉异常、无力和共济失调步态。患者被发现存在维生素B12缺乏。颈椎MRI显示颈髓内从C2 - C6水平有异常T2信号，仅累及后柱。住院第五天，患者报告他一直在为了娱乐目的从奶油罐中吸入一氧化二氮。根据其临床表现以及实验室和影像学检查结果，我们得出该患者患有SCD的结论。患者在接受维生素B12补充治疗后逐渐好转。对于出现感觉异常、无力且实验室检查提示维生素B12缺乏的患者，应询问其是否有娱乐性使用一氧化二氮的情况，因为其发生率正在上升。
