Physical and Rehabilitation Medicine Department, CHU Ambroise Paré, Mons, Wallonie, Belgium.
J Med Case Rep. 2023 Aug 17;17(1):350. doi: 10.1186/s13256-023-04075-w.
Nitrous oxide is a medical and household gas that has seen its use drift to recreational purpose among the young population in recent years. Significant neurological, hematological and psychiatric side effects, generally related to an induced functional vitamin B12 deficiency, have been described separately in the literature.
A 22-year-old woman of North African origin experienced an exceptional combination of polyneuropathy, bilateral pulmonary embolism and severe pancytopenia related to vitamin B12 deficiency and hyperhomocysteinemia induced by recreational nitrous oxide use. After treatment with vitamin B12 supplementation and intensive rehabilitative management, the patient progressively regained the ability to walk and her biological parameters gradually returned to normal. The pathophysiological mechanisms related to a decrease in vitamin B12 activity are the reduction of products needed for synthesis of deoxyribonucleic acid, carbohydrate or fatty acids, and the increase of hyperhomocysteinemia. Other mechanisms involving a direct action of N2O are also suspected.
This case report brings elements to support our knowledge about pathological pathway, recovery and prognosis of recreational N2O abuse complications. The general and medical population should be aware to the serious consequences of this type of consumption.
氧化亚氮是一种医用和家用气体，近年来，在年轻人中，它已被用于娱乐目的。文献中分别描述了其引起的显著的神经、血液和精神副作用，通常与诱导的功能性维生素 B12 缺乏有关。
一名 22 岁的北非裔妇女因滥用氧化亚氮（用于娱乐）导致维生素 B12 缺乏和高同型半胱氨酸血症，引起多发性神经病、双侧肺栓塞和严重全血细胞减少症。在接受维生素 B12 补充和强化康复治疗后，患者逐渐恢复行走能力，其生物参数逐渐恢复正常。与维生素 B12 活性降低相关的病理生理机制包括合成脱氧核糖核酸、碳水化合物或脂肪酸所需产物减少，以及高同型半胱氨酸血症增加。还怀疑存在涉及 N2O 直接作用的其他机制。
本病例报告提供了一些依据，支持我们对娱乐性 N2O 滥用并发症的病理途径、恢复和预后的了解。普通人群和医疗人群应意识到这种消费方式的严重后果。
