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October 14, 2022

Question of the Day – Friday, October 14, 2022

What is the treatment for chronic toxicity from nitrous oxide abuse?

High dose intramuscular vitamin B12 supplementation. A typical regimen is 1000 mcg IM daily for 14 days, followed by 1000 mcg IM weekly for four weeks, and then extended to monthly. Cyanocobalamin has generally been favored for its stability over other cobalamin forms. Because it has poor oral and intravenous bioavailability, intramuscular (IM) administration is preferred Permanent cessation of nitrous oxide is essential. In the cited reference, all patients had continued activation of B12 given persistent nitrous oxide abuse and experienced progressive neurologic deficits. Other treatments may include methylcobalamin, methionine, and folate, however no standardized regimen for nitrous oxide toxicity exists.

Courtney Temple & B. Zane Horowitz (2022) Nitrous oxide abuse induced subacute combined degeneration despite patient initiated B12 supplementation, Clinical Toxicology, 60:7, 872-875, DOI: 10.1080/15563650.2022.2046772

Posted in Question Of The Day
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  • Education & Groups
    • American Board of Applied Toxicology (ABAT)
      • ABAT Exceptional Service Award
      • ABAT Newsletter
      • Sitting for the American Board of Applied Toxicology Exam
        • ABAT Examination Study Guide
      • Certification Renewal Documents
      • Life Long Learning Articles (LLSA)
      • ABAT Member Directory
        • Diplomate Verification
      • ABAT Board of Directors Contact Information
    • E-Learning
      • Research Seminar: The Nuts and Bolts of Toxicology Research
      • Advanced Hazmat Life Support Training
      • MMTI Fundamentals for Front-Line Practitioners Training
      • TOXISMO Society for the Discussion of Scientific Literature
      • ToxNow
      • Webinars
        • ABAT Journal Club Webinars
        • COVID Webinar Series
    • Toxicology Residency & Fellowship Training Programs
    • Clinical Toxicology Guidelines Collaborative
      • Recommendations
    • Fellows of AACT
    • ToxCoach Mentorship Program
    • Committees
    • Sections
      • Acute & Intensive Care
      • Addiction Toxicology Section
      • Clinical Toxicology In Sports
      • Diversity, Equity, and Inclusion Section
      • Herbs & Dietary Supplements
      • Geriatric Toxicology
      • Occupational / Environmental
      • Envenomations
      • Forensic
      • Pediatric
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      • Radiation
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    • Student Chapters
  • NACCT Annual Meeting
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