{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T11:47:33Z","timestamp":1784634453180,"version":"3.55.0"},"reference-count":21,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2022,5,23]],"date-time":"2022-05-23T00:00:00Z","timestamp":1653264000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Internal Medicine Journal"],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The chronic recreational inhalation of nitrous oxide (N<jats:sub>2<\/jats:sub>O) \u2018nanging\u2019, can have adverse neurological and psychiatric effects.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To evaluate cases of chronic N<jats:sub>2<\/jats:sub>O use presenting to two hospitals, as well as to evaluate nationally N<jats:sub>2<\/jats:sub>O deaths reported to the coroner and trends in Internet searches and social media posts related to N<jats:sub>2<\/jats:sub>O.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective review of two toxicology units, from July 2017 to October 2020, of patients presenting with chronic N<jats:sub>2<\/jats:sub>O use and neurological and\/or psychiatric symptoms. We evaluated 10\u2009years (2010\u20132019) of Internet search and social media trends involving N<jats:sub>2<\/jats:sub>O and the National Coronial Information System (NCIS) database for deaths across Australia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty\u2010two patients were identified: median age 22\u2009years, half female, 17 Asian background and 15 students. Presentations included decreased mobility or unsteady gait (<jats:italic>n<\/jats:italic> =\u200915) and psychiatric symptoms (<jats:italic>n<\/jats:italic> =\u20095). The median reported bulb use\/day was 300 (interquartile range (IQR): 200\u2013370), for a median of 6 months (IQR: 3\u201324). On magnetic resonance imaging, 10\/18 had subacute combined degeneration of the spinal cord and 7\/7 sensorimotor neuropathy on nerve conduction studies. All received high\u2010dose intramuscular vitamin B<jats:sub>12<\/jats:sub> and 11 methionine. Despite prolonged rehabilitation, nine required walking aids on discharge. Since 2017, social media posts and Internet searches for N<jats:sub>2<\/jats:sub>O increased rapidly, the latter mostly directed at obtaining N<jats:sub>2<\/jats:sub>O canisters. From the NCIS, 36 deaths were identified, 12 unintentional (recreational drug use), 20 intentional self\u2010harm and 4 traumatic.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We report a case series of symptomatic chronic N<jats:sub>2<\/jats:sub>O use, many with ongoing neurological sequelae. Furthermore, a sharp increase in Internet searches to obtain N<jats:sub>2<\/jats:sub>O cannisters was noted. Education of high\u2010risk student groups on the long\u2010term sequelae is important.<\/jats:p><\/jats:sec>","DOI":"10.1111\/imj.15391","type":"journal-article","created":{"date-parts":[[2021,5,24]],"date-time":"2021-05-24T14:20:26Z","timestamp":1621866026000},"page":"1724-1732","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Just \u2018nanging\u2019 around \u2013 harmful nitrous oxide use: a retrospective case series and review of Internet searches, social media posts and the coroner's database"],"prefix":"10.1111","volume":"52","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0079-5056","authenticated-orcid":false,"given":"Angela L.","family":"Chiew","sequence":"first","affiliation":[{"name":"Clinical Toxicology Unit Prince of Wales Hospital  Sydney New South Wales Australia"},{"name":"NSW Poisons Information Centre Sydney Children's Hospital  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacques E.","family":"Raubenheimer","sequence":"additional","affiliation":[{"name":"Discipline of Biomedical Informatics and Digital Health The University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingrid","family":"Berling","sequence":"additional","affiliation":[{"name":"NSW Poisons Information Centre Sydney Children's Hospital  Sydney New South Wales Australia"},{"name":"Department of Emergency Medicine Calvary Mater Newcastle  Newcastle New South Wales Australia"},{"name":"Department of Clinical Toxicology and Pharmacology Newcastle University  Newcastle New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas A.","family":"Buckley","sequence":"additional","affiliation":[{"name":"NSW Poisons Information Centre Sydney Children's Hospital  Sydney New South Wales Australia"},{"name":"Discipline of Biomedical Informatics and Digital Health The University of Sydney  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Therese","family":"Becker","sequence":"additional","affiliation":[{"name":"Clinical Toxicology Unit Prince of Wales Hospital  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Betty","family":"Chan","sequence":"additional","affiliation":[{"name":"Clinical Toxicology Unit Prince of Wales Hospital  Sydney New South Wales Australia"},{"name":"NSW Poisons Information Centre Sydney Children's Hospital  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Brett","sequence":"additional","affiliation":[{"name":"NSW Poisons Information Centre Sydney Children's Hospital  Sydney New South Wales Australia"},{"name":"Department of Clinical Pharmacology and Toxicology St Vincent's Hospital  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,5,23]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yrtph.2015.10.017"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajplung.00206.2014"},{"key":"e_1_2_7_4_1","unstructured":"PapanastasiouC&DietzeP.Just a laughing matter?Nitrous oxide use among a group of regular psychostimulant users in Melbourne Victoria;2021[cited 2021 Feb 01]. Available from URL:https:\/\/ndarc.med.unsw.edu.au\/resource\/just-laughing-matter-nitrous-oxide-use-among-group-regular-psychostimulant-users-melbourne"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/0269881119882532"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajad.12372"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/practneurol-2014-001071"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2019.11.003"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.5694\/mja2.50371"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.5694\/mja2.50377"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.simpa.2021.100060"},{"key":"e_1_2_7_12_1","unstructured":"ThomasJ&JonesR. Doctors warn of dangerous rise in use of \u2018nangs\u2019. ABC News 2017 [cited 2021 Feb 01]. Available from URL:https:\/\/www.abc.net.au\/news\/2017-10-16\/doctors-warn-of-dangerous-use-of-nangs-or-nitrous-oxide\/9046574"},{"key":"e_1_2_7_13_1","unstructured":"Government of South AustraliaAttorney\u2010General's Department. Crackdown on nitrous oxide canister sales. 2019 Nov 27 [cited 2021 Feb 01]. Available from URL:https:\/\/www.agd.sa.gov.au\/newsroom\/crackdown-nitrous-oxide-canister-sales2019"},{"key":"e_1_2_7_14_1","unstructured":"ChanR UporovaJ KarlssonA GibbsD PriceO&PeacockA.New South Wales Drug Trends 2020: Key Findings from the Ecstasy and Related Drugs Reporting System (EDRS) Interviews National Drug and Alcohol Research Centre. Sydney: UNSW Sydney; 2021 [cited 2021 May 01]. 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