Brain and body disconnect: A retrospective case series of subacute combined degeneration of the spinal cord from chronic nitrous oxide use in Perth, Western Australia.
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| Title: | Brain and body disconnect: A retrospective case series of subacute combined degeneration of the spinal cord from chronic nitrous oxide use in Perth, Western Australia. |
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| Authors: | Soderstrom, Jessamine (AUTHOR), Grigg, Jodie (AUTHOR), McWilliam, Owen (AUTHOR), Fatovich, Daniel (AUTHOR) |
| Source: | Drug & Alcohol Review. Sep2024, Vol. 43 Issue 6, p1636-1644. 9p. |
| Subjects: | Inhalant abuse, Magnetic resonance imaging, Vitamin B12, Warning labels, Nitrous oxide |
| Abstract: | Background: Chronic nitrous oxide (N2O) use causes inactivation of vitamin B12, resulting in neurological and psychiatric symptoms. This case series presents all N2O‐related presentations to the emergency department at Royal Perth Hospital between June 2019 and June 2021, alongside the costs of these admissions. Case Presentation: Twenty‐two patients were identified; 68% (n = 15) were male. The median age was 22.4 years (interquartile range [IQR], 20–30). Median daily number of N2O bulbs inhaled was 150 (IQR, 64–300) with a median duration of use of 9 months (IQR, 3–12). Presentations included ataxia, paraesthesia and falls (n = 18), urinary retention (n = 3) and psychotic symptoms (n = 2). Fourteen patients had severe symptoms prompting a magnetic resonance imaging of brain and spine, confirming 12 cases of subacute combined degeneration of the spinal cord. All patients had IMI vitamin B12 therapy, while 14 had oral methionine therapy. The median length of admission was 4 days (IQR 1–23 days). The median cost of admission per day for patients where costs were accessible (n = 7) was $2061 (IQR, $1903‐$2860). Discussion and Conclusions: A case series of symptomatic chronic N2O use with severe neurological sequelae and significant costs associated per admission. Triangulation of emergency department and Ecstasy and Related Drugs Reporting System data helped prompt a swift public health response, including mandatory warning labels, limits to transaction amounts and legislative changes to the Medicines and Poisons Act to make it illegal for sale if there is a suspicion that it will be abused. [ABSTRACT FROM AUTHOR] |
| Copyright of Drug & Alcohol Review is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) | |
| Database: | Psychology and Behavioral Sciences Collection |
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| Header | DbId: pbh DbLabel: Psychology and Behavioral Sciences Collection An: 179392523 AccessLevel: 6 PubType: Academic Journal PubTypeId: academicJournal PreciseRelevancyScore: 0 |
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| Items | – Name: Title Label: Title Group: Ti Data: Brain and body disconnect: A retrospective case series of subacute combined degeneration of the spinal cord from chronic nitrous oxide use in Perth, Western Australia. – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Soderstrom%2C+Jessamine%22">Soderstrom, Jessamine</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Grigg%2C+Jodie%22">Grigg, Jodie</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22McWilliam%2C+Owen%22">McWilliam, Owen</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Fatovich%2C+Daniel%22">Fatovich, Daniel</searchLink> (AUTHOR) – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="JN" term="%22Drug+%26+Alcohol+Review%22">Drug & Alcohol Review</searchLink>. Sep2024, Vol. 43 Issue 6, p1636-1644. 9p. – Name: Subject Label: Subjects Group: Su Data: <searchLink fieldCode="DE" term="%22Inhalant+abuse%22">Inhalant abuse</searchLink><br /><searchLink fieldCode="DE" term="%22Magnetic+resonance+imaging%22">Magnetic resonance imaging</searchLink><br /><searchLink fieldCode="DE" term="%22Vitamin+B12%22">Vitamin B12</searchLink><br /><searchLink fieldCode="DE" term="%22Warning+labels%22">Warning labels</searchLink><br /><searchLink fieldCode="DE" term="%22Nitrous+oxide%22">Nitrous oxide</searchLink> – Name: Abstract Label: Abstract Group: Ab Data: Background: Chronic nitrous oxide (N2O) use causes inactivation of vitamin B12, resulting in neurological and psychiatric symptoms. This case series presents all N2O‐related presentations to the emergency department at Royal Perth Hospital between June 2019 and June 2021, alongside the costs of these admissions. Case Presentation: Twenty‐two patients were identified; 68% (n = 15) were male. The median age was 22.4 years (interquartile range [IQR], 20–30). Median daily number of N2O bulbs inhaled was 150 (IQR, 64–300) with a median duration of use of 9 months (IQR, 3–12). Presentations included ataxia, paraesthesia and falls (n = 18), urinary retention (n = 3) and psychotic symptoms (n = 2). Fourteen patients had severe symptoms prompting a magnetic resonance imaging of brain and spine, confirming 12 cases of subacute combined degeneration of the spinal cord. All patients had IMI vitamin B12 therapy, while 14 had oral methionine therapy. The median length of admission was 4 days (IQR 1–23 days). The median cost of admission per day for patients where costs were accessible (n = 7) was $2061 (IQR, $1903‐$2860). Discussion and Conclusions: A case series of symptomatic chronic N2O use with severe neurological sequelae and significant costs associated per admission. Triangulation of emergency department and Ecstasy and Related Drugs Reporting System data helped prompt a swift public health response, including mandatory warning labels, limits to transaction amounts and legislative changes to the Medicines and Poisons Act to make it illegal for sale if there is a suspicion that it will be abused. [ABSTRACT FROM AUTHOR] – Name: AbstractSuppliedCopyright Label: Group: Ab Data: <i>Copyright of Drug & Alcohol Review is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.) |
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| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1111/dar.13858 Languages: – Code: eng Text: English PhysicalDescription: Pagination: PageCount: 9 StartPage: 1636 Subjects: – SubjectFull: Inhalant abuse Type: general – SubjectFull: Magnetic resonance imaging Type: general – SubjectFull: Vitamin B12 Type: general – SubjectFull: Warning labels Type: general – SubjectFull: Nitrous oxide Type: general Titles: – TitleFull: Brain and body disconnect: A retrospective case series of subacute combined degeneration of the spinal cord from chronic nitrous oxide use in Perth, Western Australia. Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Soderstrom, Jessamine – PersonEntity: Name: NameFull: Grigg, Jodie – PersonEntity: Name: NameFull: McWilliam, Owen – PersonEntity: Name: NameFull: Fatovich, Daniel IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 09 Text: Sep2024 Type: published Y: 2024 Identifiers: – Type: issn-print Value: 09595236 Numbering: – Type: volume Value: 43 – Type: issue Value: 6 Titles: – TitleFull: Drug & Alcohol Review Type: main |
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