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One month of nitrous oxide abuse causing acute vitamin B 12 deficiency with severe neuropsychiatric symptoms
  1. Michael S Lundin1,2,
  2. John Cherian1,2,
  3. Michael Nyika Andrew1,2 and
  4. Richa Tikaria1,2
  1. 1 Internal Medicine, Michigan State University, East Lansing, Michigan, USA
  2. 2 Internal Medicine, Sparrow Hospital, Lansing, Michigan, USA
  1. Correspondence to Dr Michael S Lundin, lundinmi{at}


A 21-year-old university student studying abroad in the USA presented to the emergency department with double vision, lower extremity weakness with difficulty ambulating and other neuropsychiatric symptoms. MRI of the brain and spinal cord were normal. Vitamin B12 was 78 pg/mL (58 pmol/L, reference 211–911 pg/mL). The patient had been using nitrous oxide capsules used for whipped cream recharging, which she obtained from other students, a few times daily for a month for the purpose of anxiety relief. The patient was not a vegan or vegetarian. The patient was treated with intramuscular vitamin B12 repletion with partial resolution of neurologic symptoms and discharged on vitamin B12 supplementation.

  • anxiety disorders (including ocd and ptsd)
  • drug misuse (including addiction)
  • vitamins and supplements
  • neurology

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  • Patient consent for publication Obtained.

  • Contributors MNA was the medical student who had this case. Together with JC, the junior resident, he wrote the case presentation part of the manuscript. MSL is the senior resident who wrote the discussion and the rest of the report as well as edited the case presentation after the attending, RT, reviewed it.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.