Ver el código de «Nitrous oxide toxicity»

==Background==
*Nitrous oxide toxicity is often associated with inhalation of whipped cream or small nitrous oxide cannisters ([[whippets]])
*Nitrous is much more soluble in blood and will quickly diffuse from the blood to a closed space
*Beyond the gaseous effects nitrous oxide mainly disrupts B12 by oxidizing the cobalt ion which irreversibly inhibits methionine synthase<ref>Nunn J. Clinical aspects of the interaction between nitrous oxide and vitamin B12. British Journal of Anaesthesia. 1987; 59:3-13</ref>
*Epidemiology
**Rates of nitrous oxide misuse vary significantly by country and are generally higher in Europe and the United States.
**There has been a large recent increase in global misuse. From 2015 to 2021, the World Drug Report found an increase of 10% to 20% in 12-month nitrous oxide misuse.<ref>United Nations Office on Drugs and Crime. World Drug Report 2021. 2021. [https://www.unodc.org/unodc/en/data-and-analysis/wdr2021.html]</ref>
*Most nitrous oxide misuse is sporadic and without health consequences. This and its ease of availability may lead users to erroneously view it as risk-free.
*Nitrous oxide use is undetectable by standard drug screens, making it crucial to obtain a thorough history.<ref>Agarwal P, et al. Recreational nitrous oxide-induced subacute combined degeneration of the spinal cord. Cureus. 2021;13(11):e19377. [https://pmc.ncbi.nlm.nih.gov/articles/PMC8653952/]</ref>

==Clinical Features==


==Differential Diagnosis==
===Acute complications===
*[[Pneumothorax]] (induced by forceful inhalation or high-pressure tank siphoning)
*Tympanic membrane rupture
*Tracheal trauma
*[[Air emboli]]
*Thrombotic events (rare, typically in chronic use from homocysteine elevation)
**[[Venous thromboembolism]]
**[[Acute arterial ischemia]]

===Chronic complications===
*Bone marrow suppression (from long term exposure)
**[[Leukopenia]]
**[[Megaloblastic anemia]]
**[[Thrombocytopenia]]

==Evaluation==
===Workup===

===Diagnosis===

==Management==


==Disposition==


==See Also==
*[[Nitrous oxide]]

==External Links==


==References==
<references/>
[[Category:Toxicology]]