UMEM Educational Pearls

Title: Can too much whipped cream be bad for your health? Nitrous oxide toxicity

Keywords: nitrous oxide, neurotoxicity (PubMed Search)

Posted: 9/5/2019 by Hong Kim, MD, MPH
Click here to contact Hong Kim, MD, MPH

Numerous different household products can potentially be misused/abused. One such product is whipped cream charger/propellant that contains nitrous oxide.

Acute toxicity produce dose dependent response

Euphoria
Anxiolysis
Sedation
Unconsciousness
Asphyxiation

Chronic toxicity causes myeloneuropathy (demyelination of the dorsal and lateral columns of the spinal cord) due to vitamin B12 deficiency

Extremity paresthesias
Ataxia
Peripheral sensory neuropathy (loss of vibration sense and proprioception)
Weakness
Hematologic effects: leukopenia, thrombocytopenia, megaloblastic anemia

Management

Cessation of nitrous oxide use
Vitamin B12 (cyanocobalamin) repletion (IM)

References

2019 Aug 6. doi: 10.1007/s13181-019-00726-x. [Epub ahead of print]

Nitrous oxide toxicity: case files of the carolinas medical center medical toxicology fellowship.

Shah K1, Murphy C2.