UMEM Educational Pearls


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


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


 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.