Venous thrombosis after nitrous oxide abuse, a case report

J Thromb Thrombolysis. 2020 Apr;49(3):501-503. doi: 10.1007/s11239-019-02010-9.

Abstract

Nitrous oxide is a commonly abused inhalant by adolescents and young adults. There is limited data describing the adverse effects of nitrous oxide abuse, known colloquially as "whippets". We present a 21-year-old female with no medical history who presented to the emergency department for confusion, hallucinations, weakness, and falls. She was accompanied by her roommates, who endorsed significant nitrous oxide abuse. Imaging revealed a large cerebral sinus venous thrombus with extension into the transverse sinus, sigmoid sinus and internal jugular vein. She had no prior history of venous or arterial thrombosis. Hypercoagulability workup demonstrated an elevated homocysteine level, elevated methylmalonic acid level, and normal cobalamin and folate levels. Additionally, she was found to be 11 weeks pregnant, with no prior spontaneous abortions. Genetic testing was significant for methylenetetrahydrofolate reductase polymorphisms. She was managed with enoxaparin, cobalamin and folate supplementation. Homocysteine and methylmalonic acid levels normalized after cessation of nitrous oxide use, with no recurrence of venous thrombosis. This case represents the first reported patient with a venous thrombus associated with nitrous oxide abuse.

Keywords: Homocysteine; Inhalant abuse; Nitrous oxide; Venous thrombus.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Enoxaparin / administration & dosage*
  • Female
  • Folic Acid / administration & dosage*
  • Humans
  • Nitrous Oxide / administration & dosage
  • Nitrous Oxide / adverse effects*
  • Sinus Thrombosis, Intracranial* / chemically induced
  • Sinus Thrombosis, Intracranial* / diagnostic imaging
  • Sinus Thrombosis, Intracranial* / drug therapy
  • Venous Thrombosis* / chemically induced
  • Venous Thrombosis* / diagnostic imaging
  • Venous Thrombosis* / drug therapy
  • Vitamin B 12 / administration & dosage*

Substances

  • Enoxaparin
  • Folic Acid
  • Nitrous Oxide
  • Vitamin B 12