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Pulmonary embolus associated with a rare provoking factor: recreational nitrous oxide use
  1. Aroon Bhardwaj Shah and
  2. Sindhu Bhaarrati Naidu
  1. Respiratory, Barts Health NHS Trust, London, UK
  1. Correspondence to Dr Aroon Bhardwaj Shah; aroon.bhardwajshah{at}


Pulmonary embolism (PE) is a common acute presentation which may be provoked by multiple factors. We present the unique case of a young man with no underlying health conditions who was diagnosed with bilateral PE which we believe was provoked by chronic use of nitrous oxide (NO), a potentially under-recognised risk factor for PE. NO is a substance that is commonly used recreationally, particularly among young adults in the UK. It has been shown to increase serum homocysteine levels which may create a prothrombotic state.

Our patient had raised serum homocysteine levels on admission. He was anticoagulated and discharged with advice to stop nitrous oxide use. We recommend asking patients about recreational drug use when screening for provoking factors for PE so as to offer appropriate treatment and counselling.

  • venous thromboembolism
  • haematology (drugs and medicines)
  • respiratory system
  • drugs misuse (including addiction)
  • pulmonary embolism

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  • Contributors SN conceptualised presenting the case report. Both ABS and SN managed the case, acquired patient data and composed, edited and approved the final case report. ABS liaised with the patient for consent and contributory statements.

  • 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.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

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