Vitamin B12 supplementation futile for preventing demyelination in ongoing nitrous oxide misuse

Christopher Blair, Chris Tremonti, Leon Edwards, Paul S Haber and G Michael Halmagyi
Med J Aust 2019; 211 (9): . || doi: 10.5694/mja2.50371
Published online: 4 November 2019

To the Editor: Recreational misuse of nitrous oxide remains a significant public health problem,1 sustained in part by the ready availability online of gas‐containing canisters intended for use in the catering industry. Known as “nangs” or “whippits” and usually purchased in bulk, each canister contains 8 g of nitrous oxide. When inhaled, this gives a seconds‐long “high”, which is typically prolonged by using several “nangs” in a single session. Some individuals can consume hundreds each day.

  • 1 Liverpool Hospital, Sydney, NSW
  • 2 Institute of Neuroscience, Royal Prince Alfred Hospital, Sydney, NSW
  • 3 Royal Prince Alfred Hospital, Sydney, NSW

Competing interests:

No relevant disclosures.

  • 1. Kaar SJ, Ferris J, Waldron J, et al. Up: the rise of nitrous oxide abuse. An international survey of contemporary nitrous oxide use. J Psychopharmacol 2016; 30: 395–401.
  • 2. Stabler SP. Clinical practice. Vitamin B12 deficiency. N Engl J Med 2013; 368: 149–160.
  • 3. Garakani A, Jaffe RJ, Savla D, et al. Neurologic, psychiatric, and other medical manifestations of nitrous oxide abuse: A systematic review of the case literature. Am J Addict 2016; 25: 358–369.
  • 4. Timms SR, Curé JK, Kurent JE. Subacute combined degeneration of the spinal cord: MR findings. AJNR Am J Neuroradiol 1993; 14: 1224–1227.


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