Venous thrombosis after nitrous oxide abuse, a case report
David N Pratt1, Kevin Charles Patterson2, Kai Quin3
1Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA. dpratt100@pointloma.edu.
Journal of Thrombosis and Thrombolysis
|December 11, 2019
Summary
Nitrous oxide abuse, commonly known as "whippets," can lead to serious adverse effects like venous sinus thrombosis. This case highlights the importance of considering inhalant abuse in young adults presenting with neurological symptoms and hypercoagulability.
Area of Science:
- Neurology
- Toxicology
- Hematology
Background:
- Nitrous oxide (N2O) is a frequently abused inhalant among adolescents and young adults.
- Limited data exists on the adverse effects of recreational N2O use, often termed 'whippets'.
- This case addresses the neurological and hematological complications associated with N2O abuse.
Observation:
- A 21-year-old female presented with confusion, hallucinations, weakness, and falls.
- She reported significant recreational nitrous oxide abuse.
- Imaging revealed a large cerebral sinus venous thrombus extending into the transverse sinus, sigmoid sinus, and internal jugular vein.
Findings:
- The patient exhibited elevated homocysteine and methylmalonic acid levels, indicative of vitamin B12 deficiency, despite normal cobalamin and folate levels.
- Genetic testing revealed methylenetetrahydrofolate reductase (MTHFR) polymorphisms.
- This is the first reported case of venous thrombosis linked to nitrous oxide abuse.
Implications:
- Nitrous oxide abuse can precipitate severe thrombotic events, even in individuals without a prior history of thrombosis.
- Management involved anticoagulation (enoxaparin) and supplementation with cobalamin and folate.
- Normalization of homocysteine and methylmalonic acid levels and resolution of thrombosis occurred after cessation of N2O use, underscoring the causal link.
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