Nitrous oxide "whippit" abuse presenting with cobalamin responsive psychosis
Nitin K Sethi1, Paul Mullin, Josh Torgovnick
1Department of Neurology, Saint Vincent's Hospital and Medical Centers, New York, NY 10011, USA. sethinitinmd@hotmail.com
Summary
Nitrous oxide abuse can cause vitamin B12 deficiency, leading to psychiatric issues like psychosis. Prompt treatment with cobalamin can resolve these symptoms.
Area of Science:
- Neuroscience
- Toxicology
- Nutritional Psychiatry
Background:
- Nitrous oxide (N2O) is a frequently abused inhalant.
- Chronic and acute N2O use can induce vitamin B12 deficiency, particularly in individuals with borderline vitamin B12 levels.
Observation:
- A case of a 33-year-old male presenting with psychosis due to nitrous oxide (whippit) abuse.
- The patient exhibited abnormal behavior and delusions, with low-normal vitamin B12 levels but significantly elevated methylmalonyl CoA and homocysteine.
Findings:
- Intramuscular cobalamin (vitamin B12) treatment effectively resolved the patient's psychiatric symptoms.
- Elevated methylmalonyl CoA and homocysteine levels are sensitive indicators of functional vitamin B12 deficiency.
Implications:
- Clinicians should consider vitamin B12 deficiency in patients with psychiatric manifestations and a history of nitrous oxide exposure.
- Early diagnosis and treatment of vitamin B12 deficiency are crucial for managing neuropsychiatric sequelae of N2O abuse.
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