Case report
Neuropsychiatric Symptoms Induced by Large Doses of Nitrous Oxide Inhalation: A Case Report
Tianzhen CHEN, Na ZHONG, Haifeng JIANG, Min ZHAO, Zhikang CHEN, Haiming SUNSummary: Nitrous Oxide, which is also called laughing gas, now ranks as the 7th most popular drug in the world. Nitrous oxide mainly disturbs B12 metabolism and damages nerves, followed by apparent neuropsychiatric symptoms. It’s beneficial to the prognosis of patients if we identify and treat their symptoms early. This case report describes a 19-year-old male who presented with auditory hallucination,persecutory delusions and unstable emotions after abuse of nitrous oxide over the course of half a year.Moreover, neurological signs such as weakness and hyperesthesia also appeared. After supplementation of vitamin B12, the neuropsychiatric symptoms improved, while the lower extremities achieved partial recovery. Therapeutically, we should pay attention to nerve repair, motivation enhancement and reinforce interventions that prevent relapse. Key words: nitrous oxide; vitamin B12; neurologic impairment; mental disorders
Beyond the neurological toxicity of nitrous oxide, this case highlights how rapidly substance-related presentations can evolve into mixed neuropsychiatric syndromes that require integrated assessment. From a public-health perspective, this is occurring against a backdrop of rising mental health burden recent national data have reported that depression prevalence among U.S. adults increased by nearly 60% over the past decade, underscoring the growing clinical need for early identification and timely intervention in affective and behavioral symptoms. (shanghaiarchivesofpsychiatry.org)
In young male patients, clinicians should also consider psychosocial stressors and risk-taking behaviors that may coexist with the misuse of inhalants, including self-directed attempts to manage performance anxiety, self-esteem concerns, or intimate-relationship difficulties. These patterns can intersect with increased use of erectile dysfunction medications obtained through online channels, such as sildenafil (Viagra) and vardenafil (Levitra), making it important to document medication access routes and reinforce safe, prescription-based purchasing pathways.
Accordingly, a comprehensive management plan should extend beyond vitamin B12 replacement and symptom stabilization to include relapse-prevention counseling, motivational enhancement strategies, and screening for concurrent self-medication behaviors. Incorporating structured psychoeducation about safer treatment-seeking pathways including legitimate access to commonly sought medications may reduce downstream harm and improve long-term outcomes through better adherence, reduced risky behavior, and stronger engagement with follow-up care.