TY - JOUR
T1 - Nitrous oxide abuse leading to extreme homocysteine levels and thrombosis in young adults
T2 - a case series
AU - Caris, Martine G.
AU - Kuipers, Remko S.
AU - Kiestra, Baruch E.
AU - Ruijter, Barry J.
AU - Riezebos, Robert K.
AU - Coppens, Michiel
AU - Mooij, Hans L.
N1 - Funding Information: M.G.C. and H.L.M. designed the study. M.G.C. B.E.K. and B.J.R. collected the data. M.G.C. drafted the first version of the manuscript, with additions by R.S.K. and H.L.M. B.E.K. B.J.R. R.K.R. and M.G.C. critically revised the manuscript. All authors read and approved the final version of the manuscript and agree with its submission to the Journal of Thrombosis and Haemostasis. There are no competing interests to disclose. Publisher Copyright: © 2022 International Society on Thrombosis and Haemostasis
PY - 2023/2/1
Y1 - 2023/2/1
N2 - Background: Neurologic complications from recreational use of nitrous oxide (N 2O), which are attributed to vitamin B12 deficiency, have been well documented. With increasing dosages and frequency of N 2O use, an additional association with thromboembolisms is becoming apparent. Objectives: To assess thrombotic complications of recreational N 2O use. Methods: All medical charts at the largest hospital in Amsterdam were searched for N 2O use and subsequent neurologic and/or thrombotic events. For patients with thrombotic events, we extracted data on the risk factors for arterial and venous thrombosis as well as serum vitamin B12 and homocysteine concentrations. Results: Between January 2015 and May 2021, 326 patients who reported recreational use of N 2O were identified; of these, 17 (5%) patients presented with severe thrombotic events associated with N 2O (71% men; median age, 26 years [range, 18-53 years]), 5 patients presented with arterial thrombosis (3 with acute coronary syndrome, 1 with femoral artery thrombosis, and 1 with middle cerebral artery thrombus), and 12 patients presented with venous thromboembolisms (10 with pulmonary embolisms, 1 with portal vein thrombosis and 1 with cerebral vein thrombosis). Additionally, homocysteine were concentrations severely increased (median, 125 μmol/L [range, 22-253 μmol/L]; reference, <15 μmol/L). Patients reported use of 400 to 6000 g (ie, 50-750 balloons) of N 2O in 1 day. Fifty percent of these patients had experienced neurologic symptoms before the thrombotic event. Conclusion: We describe an alarming incidence of serious thrombotic events among young adults after excessive recreational use of N 2O, accompanied by extremely high homocysteine concentrations. The upward trend in the recreational use of N 2O warrants more awareness of its dangers among both users and medical professionals. Furthermore, these findings could reopen the discussion on possible associations between hyperhomocysteinemia and thrombosis mediated through N 2O.
AB - Background: Neurologic complications from recreational use of nitrous oxide (N 2O), which are attributed to vitamin B12 deficiency, have been well documented. With increasing dosages and frequency of N 2O use, an additional association with thromboembolisms is becoming apparent. Objectives: To assess thrombotic complications of recreational N 2O use. Methods: All medical charts at the largest hospital in Amsterdam were searched for N 2O use and subsequent neurologic and/or thrombotic events. For patients with thrombotic events, we extracted data on the risk factors for arterial and venous thrombosis as well as serum vitamin B12 and homocysteine concentrations. Results: Between January 2015 and May 2021, 326 patients who reported recreational use of N 2O were identified; of these, 17 (5%) patients presented with severe thrombotic events associated with N 2O (71% men; median age, 26 years [range, 18-53 years]), 5 patients presented with arterial thrombosis (3 with acute coronary syndrome, 1 with femoral artery thrombosis, and 1 with middle cerebral artery thrombus), and 12 patients presented with venous thromboembolisms (10 with pulmonary embolisms, 1 with portal vein thrombosis and 1 with cerebral vein thrombosis). Additionally, homocysteine were concentrations severely increased (median, 125 μmol/L [range, 22-253 μmol/L]; reference, <15 μmol/L). Patients reported use of 400 to 6000 g (ie, 50-750 balloons) of N 2O in 1 day. Fifty percent of these patients had experienced neurologic symptoms before the thrombotic event. Conclusion: We describe an alarming incidence of serious thrombotic events among young adults after excessive recreational use of N 2O, accompanied by extremely high homocysteine concentrations. The upward trend in the recreational use of N 2O warrants more awareness of its dangers among both users and medical professionals. Furthermore, these findings could reopen the discussion on possible associations between hyperhomocysteinemia and thrombosis mediated through N 2O.
KW - folic acid
KW - hyperhomocysteinemia
KW - nitrous oxide
KW - thrombosis
KW - vitamin B12
UR - http://www.scopus.com/inward/record.url?scp=85147894994&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jtha.2022.10.002
DO - https://doi.org/10.1016/j.jtha.2022.10.002
M3 - Article
C2 - 36700505
SN - 1538-7933
VL - 21
SP - 276
EP - 283
JO - Journal of thrombosis and haemostasis
JF - Journal of thrombosis and haemostasis
IS - 2
ER -