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[1]
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)
Chronic complications
- Bone marrow suppression (from long term exposure)
Evaluation
Workup
Diagnosis
Management
Disposition
See Also
External Links
References
- ↑ Nunn J. Clinical aspects of the interaction between nitrous oxide and vitamin B12. British Journal of Anaesthesia. 1987; 59:3-13