Nitrous oxide abuse resulting in sub-acute combined degeneration of the spinal cord

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dc.contributor.author Kenny, O en
dc.contributor.author Sundram, Frederick en
dc.coverage.spatial Nelson, New Zealand en
dc.date.accessioned 2020-01-12T22:45:38Z en
dc.date.issued 2019-09-18 en
dc.identifier.citation RANZCP 2019 New Zealand Conference. 18 Sep 2019 en
dc.identifier.uri http://hdl.handle.net/2292/49585 en
dc.description.abstract INTRODUCTION: Nitrous oxide (N2O) is widely used as a recreational drug and most users regard it as an innocuous substance ¹ although sustained use of N2O can have significant adverse neurological effects due to the inactivation of vitamin B12 ². This is a case of a previously fit and healthy 33 year old health professional who developed sub-acute combined degeneration of the spinal cord secondary to repeated N2O use. CASE PRESENTATION: A 33 year old man presented with deterioration in mental state over one month. There were concerns that he was developing a mood disorder and he was admitted to the mental health inpatient unit. However, early in his admission, a recent history of heavy N2O abuse was disclosed - the patient had been using the internet to source large quantities of N2O canisters. His substance use accounted for the change in his mental state. Neurological deficits, which were in keeping with N2O toxicity, were also noted including confusion, ataxia and impaired proprioception. MRI confirmed diffuse cord signal abnormality in the dorsal columns. MANAGEMENT AND OUTCOME: Following initial management at the mental health inpatient unit, he was subsequently transferred to a medical ward. He was commenced on regular intramuscular B12 injections which continued for several weeks. He had intensive input from physiotherapy, occupational therapy and neurology. There was robust family support throughout his admission. He made significant improvement as an inpatient over a period of three weeks and was discharged with a plan for community follow-up for physical and mental health needs. DISCUSSION: It is important that clinicians are aware of the serious adverse consequences of heavy N2O use so they can appropriately recognize neurological consequences of N2O use and also educate the public on its potentially hazardous effects. en
dc.relation.ispartof RANZCP 2019 New Zealand Conference en
dc.rights Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher. en
dc.rights.uri https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm en
dc.title Nitrous oxide abuse resulting in sub-acute combined degeneration of the spinal cord en
dc.type Conference Poster en
dc.rights.holder Copyright: The authors en
dc.rights.accessrights http://purl.org/eprint/accessRights/OpenAccess en
pubs.elements-id 786219 en
pubs.org-id Medical and Health Sciences en
pubs.org-id School of Medicine en
pubs.org-id Psychological Medicine Dept en
pubs.record-created-at-source-date 2019-11-20 en


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