Nitrous oxide, commonly known as laughing gas, is composed of nitrogen and oxygen and is colorless, odorless, inexpensive, and relatively easy to obtain. Misuse of nitrous oxide, which has increased markedly in the U.S. and worldwide among teens and young adults over the past decade, may have serious adverse health effects. Although it is typically used in medical and dental settings for anesthesia and pain control, some industrial and commercial products such as whipped cream dispensers and aerosol cooking sprays also use nitrous oxide. When inhaled, nitrous oxide provides euphoric, relaxing, and hallucinogenic effects lasting about 30 seconds to two minutes.
Recreational use of nitrous oxide most commonly occurs through commercially produced items such as food processing propellants for whipped cream or culinary use or from the purchase of chargers, which are small metal containers filled with the gas. To inhale nitrous oxide from the charger, a small handheld device is used to pierce the foil seal, and nitrous oxide is filled into a balloon and then inhaled. Less commonly, nitrous oxide may be misused by inhaling it directly from anesthesia tanks.
Because nitrous oxide chargers release gas at very low temperatures (-40 0C/0F or colder), people who inhale the gas directly from a charger can develop severe frostbite on the lips, mouth, throat, and lungs. Inhalation can cause a life-threatening condition in which air accumulates between the lung and chest wall (pneumothorax), causing lung collapse. In addition, nitrous oxide inhaled at high concentrations can cause seizures and, rarely, acute psychosis, coma, or death. Because nitrous oxide blocks the activity of vitamin B12 (cobalamin), an essential nutrient for red blood cells and nerve function, long term use of nitrous oxide may cause anemia (secondary pernicious anemia), numbness and tingling in the hands and feet, gait imbalance, muscle weakness, and, rarely, paralysis. Some of these neurological complications may be permanent. Long-term nitrous oxide misuse is also associated with delusions, hallucinations, paranoia, and depression. Less commonly, those who misuse nitrous oxide on a long-term basis may develop blood clots, stroke, and heart attack.
A medical toxicologist or a Poison Control Center (1-800-222-1222) should be consulted for individuals presenting with potential complications of nitrous oxide misuse. Treatment obviously includes discontinuation of nitrous oxide use and possibly high-dose cobalamin (vitamin B12) given orally or by intramuscular injection weekly to monthly until anemia or neurological symptoms improve. Those with persistent neurological deficits may benefit from physical rehabilitation programs. Individuals with nitrous oxide misuse may be referred to counseling for substance-use disorder, and some may receive mental health counseling and treatment. Prevention of nitrous oxide misuse may include community-based education campaigns via social media or interactive workshops targeting groups at high risk of nitrous oxide misuse (teens and young adults). Prevention measures also include regulatory policy actions targeting suppliers to restrict easy access to and availability of large containers, scented formulations, and online sales of nitrous oxide.
For more information go to the website of the U.S. Food and Drug Administration at www.fda.gov
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