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Journal of Medical Toxicology

, Volume 2, Issue 2, pp 71–74 | Cite as

Nitrous oxide “Whippit” abuse presenting with cobalamin responsive psychosis

  • Nitin K. Sethi
  • Paul Mullin
  • Josh Torgovnick
  • Giuseppe Capasso
Toxicology Observations

Abstract

Introduction

Nitrous oxide is a commonly abused inhalant drug. It is known to precipitate vitamin B12 deficiency when used chronically and acutely, especially in people having marginal vitamin B12 reserve.

Case report

We are presenting a case of nitrous oxide “whippit” abuse in a thirty-three-year-old male with bizarre behavior and delusions. The patient had low normal levels of vitamin B12 (202 pg/ml), but he had markedly high methylmalonyl CoA (1078 nmol/L) and homocysteine (48.4 mcmol/L). Treatment with intramuscular cobalamin led to a resolution of his psychosis.

Discussion

This case report highlights the need to consider vitamin B12 deficiency in patients who arrive at a hospital with psychiatric manifestations and who report having a history of nitrous oxide exposure or abuse in the recent or remote past. A review of the literature on the neuropsychological manifestations of vitamin B12 deficiency is provided.

Keywords

Nitrous Oxide Homocysteine Cyanocobalamin Medical Toxicology Volume Bizarre Behavior 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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Copyright information

© American College of Medical Toxicology 2006

Authors and Affiliations

  • Nitin K. Sethi
    • 1
  • Paul Mullin
    • 1
  • Josh Torgovnick
    • 1
  • Giuseppe Capasso
    • 1
  1. 1.Department of NeurologySaint Vincent’s Hospital and Medical CentersNew York

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