Podcast 745: Nitrous-Induced B12 Deficiency

<p><strong>Contributor: Alicia Oberle, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Nitrous oxide (N₂O) can cause a vitamin B12 deficiency in patients after regular use</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">N₂O is used in procedural sedation but also as a popular recreational drug </span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">N₂O binds and inactivate B12 in the body, therefore decreasing usable supply</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Lack of B12, which is essential for myelinating nerves, can lead to subacute combined degeneration of the spinal cord</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Presentation may include paresthesias, ataxia, gait changes, or bilateral lower extremity motor weakness</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">B12 can be normal on labs, as the B12 is present but activated</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Treatment is daily B12 injections and oral supplementation</span></li> </ul> <p><strong>References</strong></p> <p><span style="font-weight: 400;">Stockton L, Simonsen C, Seago S. Nitrous oxide-induced vitamin B12 deficiency. Proc (Bayl Univ Med Cent). 2017;30(2):171-172. doi:10.1080/08998280.2017.11929571</span></p> <p><span style="font-weight: 400;">Samia AM, Nenow J, Price D. Subacute Combined Degeneration Secondary to Nitrous Oxide Abuse: Quantification of Use With Patient Follow-up. Cureus. 2020;12(10):e11041. Published 2020 Oct 19. doi:10.7759/cureus.11041</span></p> <p><span style="font-weight: 400;">Edigin E, Ajiboye O, Nathani A. Nitrous Oxide-induced B12 Deficiency Presenting With Myeloneuropathy. Cureus. 2019;11(8):e5331. Published 2019 Aug 6. doi: