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A Novel Inhalation Mask System to Deliver High Concentrations of Nitric Oxide Gas in Spontaneously Breathing Subjects
Published on: May 4, 2021
Fatal pulmonary thromboembolism associated with excessive nitrous oxide consumption over several weeks
Stefanie Plenzig1, Friederike Pijahn2, Alexander Müller3
1Institute of Legal Medicine, Goethe University, University Hospital, Frankfurt, Germany. plenzig@med.uni-frankfurt.de.
International Journal of Legal Medicine
|August 12, 2026
Summary
Excessive nitrous oxide use can lead to vitamin B12 deficiency, causing blood clots and fatal pulmonary embolism in young adults. This highlights the severe health risks associated with recreational nitrous oxide abuse.
Area of Science:
- Medical Toxicology
- Hematology
- Nutritional Biochemistry
Background:
- Recreational nitrous oxide (N2O) abuse is increasingly recognized.
- N2O is known to inactivate vitamin B12, a crucial cofactor for methionine synthase.
- Vitamin B12 deficiency can lead to hyperhomocysteinemia, a risk factor for thromboembolic events.
Purpose of the Study:
- To investigate the potential link between excessive nitrous oxide consumption and fatal thromboembolic events.
- To highlight the diagnostic challenges and clinical implications of N2O-induced vitamin B12 deficiency.
Main Methods:
- Case report of a young adult male with fatal pulmonary embolism.
- Autopsy and toxicological analysis for N2O.
- Assessment of vitamin B12 levels and related metabolic markers.
Main Results:
- The patient presented with acute N2O intoxication, diagnosed vitamin B12 deficiency, and anemia.
- He subsequently died from a pulmonary embolism secondary to deep vein thrombosis.
- Autopsy confirmed N2O exposure; hyperhomocysteinemia due to vitamin B12 deficiency was suspected as a contributing factor.
Conclusions:
- Repeated excessive N2O consumption can cause functional vitamin B12 deficiency and metabolic disturbances.
- This deficiency may contribute to thromboembolic events, particularly in young individuals with risk factors like obesity and nicotine abuse.
- While toxicology can confirm N2O exposure, establishing the underlying biochemical pathology requires further investigation.
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