{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T18:27:09Z","timestamp":1759775229747,"version":"3.44.0"},"reference-count":19,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,7,6]]},"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:p>A 32-year-old woman who misused multiple substances, including nitrous oxide (N<jats:sub>2<\/jats:sub>O), sought medical advice after she subacutely developed bilateral lower extremity weakness without a sensory level but with ataxia\u2014her significant other developed similar symptoms with vitamin B<jats:sub>12<\/jats:sub> deficiency due to N<jats:sub>2<\/jats:sub>O intake. Laboratory results revealed macrocytic anaemia despite normal B<jats:sub>12<\/jats:sub> and folate levels, with serum markers pointing towards functional cobalamin deficiency. Spinal MRIs and cerebrospinal fluid analysis were unremarkable. Our patient was treated with vitamin B<jats:sub>12<\/jats:sub> supplementation with an encouraging response.<\/jats:p>","DOI":"10.1136\/bcr-2020-241414","type":"journal-article","created":{"date-parts":[[2021,7,21]],"date-time":"2021-07-21T12:58:04Z","timestamp":1626872284000},"page":"e241414","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Important reminder: nitrous oxide (N<sub>2<\/sub>O) as a cause of functional vitamin B<sub>12<\/sub> deficiency"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5628-7202","authenticated-orcid":false,"given":"Abdullahi Elsheikh","family":"Mahgoub","sequence":"first","affiliation":[{"name":"Internal Medicine, Hurley Medical Center, Flint, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5239-9533","authenticated-orcid":false,"given":"Smit Sunil","family":"Deliwala","sequence":"additional","affiliation":[{"name":"Internal Medicine, Hurley Medical Center, Flint, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8414-0067","authenticated-orcid":false,"given":"Ghassan","family":"Bachuwa","sequence":"additional","affiliation":[{"name":"Internal Medicine, Hurley Medical Center, Flint, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,7,21]]},"reference":[{"key":"2025082702193961000_14.7.e241414.1","doi-asserted-by":"publisher","DOI":"10.1186\/s12875-016-0514-z"},{"key":"2025082702193961000_14.7.e241414.2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2016-10-569186"},{"key":"2025082702193961000_14.7.e241414.3","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1093\/ajcn\/60.1.2","article-title":"Prevalence of cobalamin deficiency in the Framingham elderly population","volume":"60","author":"Lindenbaum","year":"1994","journal-title":"Am J Clin Nutr"},{"key":"2025082702193961000_14.7.e241414.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.mcna.2016.09.013"},{"key":"2025082702193961000_14.7.e241414.5","doi-asserted-by":"crossref","DOI":"10.3390\/nu11020450","article-title":"Methylmalonic acid and homocysteine as indicators of vitamin B12 deficiency in patients with gastric cancer after gastrectomy","volume":"11","author":"Lee","year":"2019","journal-title":"Nutrients"},{"key":"2025082702193961000_14.7.e241414.6","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1097\/DSS.0000000000001464","article-title":"Use of nitrous oxide in dermatology: a systematic review","volume":"44","author":"Brotzman","year":"2018","journal-title":"Dermatol Surg"},{"key":"2025082702193961000_14.7.e241414.7","doi-asserted-by":"publisher","DOI":"10.2344\/0003-3006(2007)54[9:AIUTAO]2.0.CO;2"},{"key":"2025082702193961000_14.7.e241414.8","unstructured":"Elkins C . 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