Bizouard Thomas, Caplette Catherine, Duval Damien, Savary Dominique, Douillet Delphine
Department of Emergency Medicine, University Hospital of Angers, 49100, Angers, France.
EHESP, Irset (Institut de Recherche en Santé, SFR ICAT, Univ Angers, CHU Angers, Univ Rennes, CAPTV CDC, Environnement Et Travail) - UMR_S 1085, InsermAngers, France.
Int J Emerg Med. 2024 Nov 4;17(1):169. doi: 10.1186/s12245-024-00689-z.
The recreational use of nitrous oxide is becoming increasingly common among teenagers and young adults. Since 2018, the use of nitrous oxide has increased exponentially and has become a public health problem.
A 23-year-old patient was referred to accident and emergency (A&E) by his general practitioner for deterioration in general condition, vomiting, diarrhea and febrile headache at 39 °C. He reported that he had been partying for a month and consuming alcohol, cannabis and nitrous oxide. Three days before the consultation, he reported increased abdominal pain in the right iliac fossa. His homocysteine concentration was 51.9 μmol/L, and his plasma methyl malonate concentration increased to 4.45 μmol/L. A thoracic and abdominal CT scan revealed right iliac venous thrombosis associated with bilateral pulmonary embolism.
Nitrous oxide inhibits the activity of methionine synthetase. We therefore observed an increase in plasma homocysteine and 5-methyl-THF. The increase in homocysteine could be responsible for the pro-thrombotic activity resulting from nitrous oxide intoxication. At present, no threshold or duration of exposure has been identified as being particularly likely to cause complications. It is likely that other factors coexist, such as coagulation disorders and polymorphisms of the MHTFR gene, which can lead to hyperhomocysteinaemia, cannabis consumption, inflammatory conditions and others. Treatment is based on vitamin B12 supplementation and curative anticoagulation. Some authors also recommend folate supplementation. Consumption of nitrous oxide could be associated with arterial and venous thromboembolic disease.
一氧化二氮的娱乐性使用在青少年和年轻人中越来越普遍。自2018年以来，一氧化二氮的使用呈指数级增长，并已成为一个公共卫生问题。
一名23岁患者被其全科医生转诊至急诊室，原因是全身状况恶化、呕吐、腹泻以及39°C的发热性头痛。他报告称自己已经狂欢了一个月，同时饮酒、吸食大麻和一氧化二氮。在就诊前三天，他报告右下腹疼痛加剧。他的同型半胱氨酸浓度为51.9μmol/L，血浆甲基丙二酸浓度升至4.45μmol/L。胸部和腹部CT扫描显示右髂静脉血栓形成并伴有双侧肺栓塞。
一氧化二氮会抑制甲硫氨酸合成酶的活性。因此，我们观察到血浆同型半胱氨酸和5-甲基四氢叶酸增加。同型半胱氨酸的增加可能是一氧化二氮中毒导致血栓形成活性增加的原因。目前，尚未确定特别可能导致并发症的暴露阈值或持续时间。很可能存在其他并存因素，如凝血障碍和MHTFR基因多态性，这些因素可导致高同型半胱氨酸血症、吸食大麻、炎症状态等。治疗基于补充维生素B12和进行治疗性抗凝。一些作者还建议补充叶酸。一氧化二氮的使用可能与动脉和静脉血栓栓塞性疾病有关。
