Brain and body disconnect: A retrospective case series of subacute combined degeneration of the spinal cord from chronic nitrous oxide use in Perth, Western Australia

September 2024
Citation: 
Soderstrom, J., Grigg, J., McWilliams, O. and Fatovich, D. (2024). Brain and body disconnect: A retrospective case series of subacute combined degeneration of the spinal cord from chronic nitrous oxide use in Perth, Western Australia. Medical Journal of Australia. DOI: https://doi.org/10.1111/dar.13858

Chronic use of nitrous oxide (N2O) causes inactivation of vitamin B12, resulting in neurological and psychiatric symptoms.

This case series presents all N2O-related presentations to the emergency department at Royal Perth Hospital between June 2019 and June 2021, alongside the costs of these admissions.

Among other findings, this case series showed the median daily number of N2O bulbs inhaled was 150, median duration of use was 9 months and common presentations included ataxia, paraesthesia and falls. More than half had subacute combined degeneration of the spinal cord.

Triangulation of emergency department and Ecstasy and Related Drugs Reporting System data helped prompt a swift public health response, including mandatory warning labels, limits to transaction amounts and legislative changes to the Medicines and Poisons Act to make it illegal for sale if there is a suspicion that it will be abused.

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