Lander Megan E, Lander Skye J, Park James, Chae Chul
School of Medicine, California University of Science and Medicine, Colton, USA.
Radiology, Arrowhead Regional Medical Center, Colton, USA.
Cureus. 2024 Jul 22;16(7):e65155. doi: 10.7759/cureus.65155. eCollection 2024 Jul.
Nitrous oxide (NO) has been thought to be a harmless recreational substance by public perception, but it has been linked to subacute combined degeneration (SACD) due to induction of a functional vitamin B12 deficiency via oxidation and inactivation of the cobalt ion in its molecular structure. NO has been rising in popularity due to several factors including accessibility, low cost, and low perceived risk, leading otherwise healthy people to develop what used to be a neurological disease experienced by select patient populations with dietary restrictions or medical conditions leading to low levels of vitamin B12. Vitamin B12 plays a crucial role in many cellular processes, and loss of functional vitamin B12 cannot be detected by measuring it directly. Substrates from its metabolic pathways such as homocysteine and methylmalonic acid must be measured to check its functional status. Vitamin B12 deficiency also leads to a hypercoagulable state due to the build-up of homocysteine in the blood. We present the case of a 26-year-old male who had reportedly used NO for six months leading to SACD and a popliteal deep vein thrombosis. The options for treatment are abstaining from substance use and vitamin B12 supplementation; however, full recovery after SACD develops is unlikely and patients may be left with permanent neurological dysfunction from NO use.
一氧化二氮（NO）在公众认知中一直被认为是一种无害的消遣性物质，但由于其分子结构中的钴离子被氧化并失活，从而导致功能性维生素B12缺乏，它已与亚急性联合变性（SACD）有关。由于多种因素，包括可及性、低成本和低感知风险，NO的使用越来越普遍，导致原本健康的人患上了过去只有特定饮食受限或患有导致维生素B12水平低的疾病的患者群体才会出现的神经疾病。维生素B12在许多细胞过程中起着关键作用，而功能性维生素B12的缺失无法通过直接测量来检测。必须测量其代谢途径中的底物，如高半胱氨酸和甲基丙二酸，以检查其功能状态。由于血液中高半胱氨酸的积累，维生素B12缺乏还会导致血液高凝状态。我们报告了一例26岁男性的病例，据报道他使用NO六个月后导致了SACD和腘静脉深静脉血栓形成。治疗选择是戒除物质使用和补充维生素B12；然而，SACD发生后完全恢复不太可能，患者可能会因使用NO而留下永久性神经功能障碍。
