Doctors warn of emerging public health issue from recreational use of laughing gas

Nitrous oxide – otherwise known as laughing gas – is regularly used by doctors and dentists to sedate patients undergoing minor procedures while it is also used as in aerosol, a fuel additive and an additive to whipped cream. File photo 

Doctors at one of Ireland’s largest hospitals have warned that the increasing use of nitrous oxide as a recreational drug is an emerging public health issue as it can lead to the deterioration of a user’s nervous system and spinal cord.

Medical staff at St James’ Hospital in Dublin have expressed concern about two cases of young men who presented in the hospital’s emergency department with progressive disorders of nerves in their arms and legs related to their use of nitrous oxide.

The drug – otherwise known as laughing gas – is regularly used by doctors and dentists to sedate patients undergoing minor procedures while it is also used as in aerosol, a fuel additive and an additive to whipped cream.

However, it has also become increasingly used as a recreational drug in recent years due to its easy availability and lack of significant after-effects. According to the most recent World Drug Survey, it is the 14th most popular recreational drug worldwide.

Medical staff at St James’ Hospital in Dublin have expressed concern about two cases of young males who presented in the hospital’s emergency department with progressive disorders of nerves in their arms and legs related to their use of nitrous oxide. File photo: RollingNews.ie

While there is little data about the prevalence of the use of nitrous oxide in the Republic, anecdotal evidence suggests its use is on the increase as canisters of the drug are readily available and can be purchased through major online retailers where they are marketed as “cream chargers.” 

In the first case at St James’ Hospital, doctors said a 20-year-old man attended its emergency department with a two-week history of progressive sensory changes affecting all four limbs. The patient reported mild numbness in his fingers and toes for several weeks which had begun to spread to other parts of his body.

It was followed by the patient experiencing pain in his limbs and becoming increasingly unsteady on his feet. The patient admitted heavy use of nitrous oxide twice a week for the preceding six weeks, typically consuming 20 balloons per session before switching from individual canisters to larger cylinders.

He also reported using cannabis on a daily basis as well as the occasional use of cocaine and ketamine. Tests found the patient had enlarged red blood cells with low levels of B12 vitamin and loss of reflex as well as deterioration in the nerves that control the muscles and compression of the spinal cord.

The patient discharged himself against medical advice after seven days of treatment. However, he reported improvement in his strength and balance two months later but was still suffering from a burning or prickly sensation and numbness in his fingers and toes.

A second patient with similar symptoms of tingling and weakness in all four limbs, who was unable to walk unassisted, also attended the hospital. The 21-year-old man said he was unable to distinguish between keys and coins in his pocket and had fallen a number of times on stairs in the preceding days.

The patient said he had stopped driving three days before going to hospital as he felt he could not coordinate his limbs and his bowels had not opened in a week.

Doctors noted that he had been using nitrous oxide once a fortnight for the preceding seven months, usually in quantities of 10 to 40 balloons per session. The patient said his group of friends would typically consume five large cylinders of the gas at a house party.

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Various scans and tests conducted on the patient showed a mixed central and peripheral sensory and motor loss similar to the first case. Following treatment with high doses of vitamin B12 and folic acid, his symptoms improved significantly and he regained the ability to walk independently.

In a case review published in the Irish Journal of Medical Science, doctors at St James’ Hospital said most patients would see significant improvement within months with appropriate treatment, although persistent sensory symptoms are not uncommon.

They claimed more severe residual impairment had been reported among patients who continued to use nitrous oxide.

“It is important that clinicians are aware of this evolving public health issue and are able to recognise the clinical features of this rare presentation, which may become more common in Irish EDs (emergency departments) and GP surgeries as nitrous oxide abuse becomes more prevalent,” they added.