Nitrous oxide irreversibly oxidizes the central cobalt moiety of B12 rendering it nonfunctional. What does this result in?
Elevations in homocysteine and methylmalonic acid.
Temple C et al. Nitrous oxide abuse induced subacute combined degeneration despite patient initiated B12 supplementation. Clin Tox. 2021; 872-875. doi/full/10.1080/15563650.2022.2046772
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