{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T17:58:19Z","timestamp":1787162299866,"version":"build-2736575974"},"reference-count":19,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,2,27]]},"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:p>\n                    Recreational nitrous oxide (N\n                    <jats:sub>2<\/jats:sub>\n                    O) is commonly used among young people partly due to its low cost and accessibility, and awareness of its potential adverse effects is poor in this group. One such adverse effect is degeneration of the spinal cord due to its disruption of DNA synthesis by inactivating cobalamin (B\n                    <jats:sub>12<\/jats:sub>\n                    ).\n                  <\/jats:p>\n                  <jats:p>A 19-year-old man presented to the emergency department with a 4-week history of worsening paraesthesia in his fingers and lower limbs, and weakness in the hands and lower limbs for 2\u2009weeks. On examination, he had an ataxic gait, reduced power of grip strength and ankle movements, and impaired sensation in the lower limbs. An MRI brain and spine revealed myelopathy of the cervical and thoracic cord.<\/jats:p>\n                  <jats:p>\n                    On further questioning, he reported recreational N\n                    <jats:sub>2<\/jats:sub>\n                    O inhalation. His symptoms improved after stopping this and he was treated with supplementation of B vitamins. Education strategies regarding the risks of N\n                    <jats:sub>2<\/jats:sub>\n                    O misuse are indicated.\n                  <\/jats:p>","DOI":"10.1136\/bcr-2020-240447","type":"journal-article","created":{"date-parts":[[2021,3,15]],"date-time":"2021-03-15T11:40:43Z","timestamp":1615808443000},"page":"e240447","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Inhaled nitrous oxide-induced functional B\n                    <sub>12<\/sub>\n                    deficiency"],"prefix":"10.1136","volume":"14","author":[{"given":"Yorissa","family":"Padayachee","sequence":"first","affiliation":[{"name":"Emergency Medicine, Imperial College Healthcare NHS Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Richards","sequence":"additional","affiliation":[{"name":"Emergency Medicine, Imperial College Healthcare NHS Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Owen","family":"Morgan","sequence":"additional","affiliation":[{"name":"Emergency Medicine, Imperial College Healthcare NHS Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,3,15]]},"reference":[{"key":"2025082708042177000_14.3.e240447.1","doi-asserted-by":"crossref","first-page":"12","DOI":"10.2174\/1874473711666181008163107","article-title":"Mini-Review: a brief history of nitrous oxide (N2O) use in neuropsychiatry","volume":"11","author":"Gillman","year":"2019","journal-title":"Curr Drug Res Rev"},{"key":"2025082708042177000_14.3.e240447.2","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aev297"},{"key":"2025082708042177000_14.3.e240447.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0376-8716(00)00215-5"},{"key":"2025082708042177000_14.3.e240447.4","doi-asserted-by":"crossref","DOI":"10.3389\/fpsyt.2017.00312","article-title":"No Laughing Matter: Presence, Consumption Trends, Drug Awareness, and Perceptions of \"Hippy Crack\" (Nitrous Oxide) among Young Adults in England","volume":"8","author":"Ehirim","year":"2017","journal-title":"Front Psychiatry"},{"key":"2025082708042177000_14.3.e240447.5","first-page":"145","article-title":"Nitrous oxide continuing education in anaesthesia","volume":"5","author":"Banks","year":"2005","journal-title":"Critical Care & Pain"},{"key":"2025082708042177000_14.3.e240447.6","doi-asserted-by":"publisher","DOI":"10.2344\/0003-3006-55.4.124"},{"key":"2025082708042177000_14.3.e240447.7","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e3181870a17"},{"key":"2025082708042177000_14.3.e240447.8","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.2.5407.480"},{"key":"2025082708042177000_14.3.e240447.9","article-title":"Nitrous oxide-induced B12 deficiency presenting with myeloneuropathy","volume":"11","author":"Edigin","year":"2019","journal-title":"Cureus"},{"key":"2025082708042177000_14.3.e240447.10","doi-asserted-by":"publisher","DOI":"10.1159\/000353623"},{"key":"2025082708042177000_14.3.e240447.11","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1177\/0269881119882532","article-title":"Nitrous oxide causes peripheral neuropathy in a dose dependent manner among recreational users","volume":"34","author":"Winstock","year":"2020","journal-title":"J Psychopharmacol"},{"key":"2025082708042177000_14.3.e240447.12","article-title":"Nitrous oxide induced posterior cord myelopathy: beware of the methyl folate trap","volume":"12","author":"Marotta","year":"2020","journal-title":"Cureus"},{"key":"2025082708042177000_14.3.e240447.13","unstructured":"Winstock AR . Global Drug Survey Executive Summary 2019. [London]: GDS, 2019. Available: https:\/\/www.drugsandalcohol.ie\/30537\/1\/Exec-Summary.pdf [Accessed 20 Oct 2020]."},{"key":"2025082708042177000_14.3.e240447.14","doi-asserted-by":"publisher","DOI":"10.3390\/nu2030299"},{"key":"2025082708042177000_14.3.e240447.15","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1212\/WNL.28.5.504","article-title":"Neuropathy following abuse of nitrous oxide","volume":"28","author":"Layzer","year":"1978","journal-title":"Neurology"},{"key":"2025082708042177000_14.3.e240447.16","doi-asserted-by":"publisher","DOI":"10.1136\/practneurol-2014-001071"},{"key":"2025082708042177000_14.3.e240447.17","doi-asserted-by":"crossref","first-page":"e105","DOI":"10.1016\/j.jemermed.2018.01.045","article-title":"Subacute Combined Degeneration from Recreational Nitrous Oxide Inhalation","volume":"54","author":"Antonucci","year":"2018","journal-title":"J Emerg Med"},{"key":"2025082708042177000_14.3.e240447.18","doi-asserted-by":"publisher","DOI":"10.3390\/nu5114521"},{"key":"2025082708042177000_14.3.e240447.19","unstructured":"National Institute for Health and Care Excellence (NICE) Clinical Knowledge Summaries (CKS) . Scenario: Management of anaemia - vitamin B12 and folate deficiency. [Internet]. [London]: NICE. Clinical guideline, 2018. Available: https:\/\/cks.nice.org.uk\/topics\/anaemia-b12-folate-deficiency\/ [Accessed 29 Oct 2020]."}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2020-240447","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T15:04:28Z","timestamp":1756307068000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2020-240447"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3]]},"references-count":19,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021,3,15]]},"published-print":{"date-parts":[[2021,3]]}},"alternative-id":["10.1136\/bcr-2020-240447"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2020-240447","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3]]}}}