About this episode
Contributor: Alicia Oberle, MD Educational Pearls: Nitrous oxide (N2O) can cause a vitamin B12 deficiency in patients after regular use N2O is used in procedural sedation but also as a popular recreational drug N2O binds and inactivate B12 in the body, therefore decreasing usable supply Lack of B12, which is essential for myelinating nerves, can lead to subacute combined degeneration of the spinal cord Presentation may include paresthesias, ataxia, gait changes, or bilateral lower extremity motor weakness B12 can be normal on labs, as the B12 is present but inactivated Treatment is daily B12 injections and oral supplementation References Stockton L, Simonsen C, Seago S. Nitrous oxide-induced vitamin B12 deficiency. Proc (Bayl Univ Med Cent). 2017;30(2):171-172. doi:10.1080/08998280.2017.11929571 Samia AM, Nenow J, Price D. Subacute Combined Degeneration Secondary to Nitrous Oxide Abuse: Quantification of Use With Patient Follow-up. Cureus. 2020;12(10):e11041. Published 2020 Oct 19. doi:10.7759/cureus.11041 Edigin E, Ajiboye O, Nathani A. Nitrous Oxide-induced B12 Deficiency Presenting With Myeloneuropathy. Cureus. 2019;11(8):e5331. Published 2019 Aug 6. doi:10.7759/cureus.5331 *Image obtained from Wikimedia author Hansmuller and licensed under Creative Commons Attribution-Share Alike 4.0 International license. Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at https://emergencymedicalminute.org/cme-courses/ and create an account. Donate to EMM today!