Abstract
Background: Myeloneuropathy from chronic exposure to nitrous oxide has been described.
Nitrous oxide irreversibly alters B12 activation, causing signs and symptoms of B12 deficiency. Objectives: We describe a case of myeloneuropathy secondary to acute
use of high-dose nitrous oxide. Case Report: A 24-year-old man presented to the Emergency
Department complaining of numbness and tingling of his hands and feet, as well as
worsening clumsiness and gait disturbances after escalating use of nitrous oxide in
the prior 2 weeks. He was found to have dysmetria, poor proprioception, decreased
sensation to vibration and light touch over his extremities, and a mildly positive
Romberg sign. Laboratory test values revealed a normal B12 level but increased methylmalonic acid and homocysteine levels. The patient was admitted
to the hospital and started on a course of B12 injections. He was discharged after 3 days with daily B12 supplementation. Conclusions: This case demonstrates myeloneuropathic changes secondary
to acute high-dose nitrous oxide exposure.
Keywords
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Article info
Publication history
Published online: June 07, 2010
Accepted:
April 10,
2010
Received in revised form:
January 5,
2010
Received:
June 2,
2009
Identification
Copyright
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
