• W Caré, L Dufayet, M A Piot, I Crassard, P Manceau, P Niclot, A Batisse, and D Vodovar.
• Centre antipoison de Paris - Fédération de toxicologie de l'AP-HP, Hôpital Lariboisière-Fernand-Widal (AP-HP), 75010 Paris, France; Service de médecine interne, Hôpital d'instruction des armées Bégin, 94160 Saint-Mandé, France; Inserm UMR S-1144, Faculté de pharmacie, 75006 Paris, France.
• Rev Med Interne. 2022 Mar 1; 43 (3): 170-177.

AbstractNitrous oxide (N2O) is used since the eighteenth century as an anesthetic and analgesic but also for recreational use. If the labelled uses of N2O and their modalities are nowadays perfectly framed, the misuse of N2O takes very alarming proportions among teenagers and young adults. This misuse is the cause of acute (hypoxia, barotrauma, burns, neuropsychiatric disorders) and chronic complications if repeated (myeloneuropathy, anemia, thrombosis, inhalant use disorder). The main mechanism of the latter is mainly related to a functional deficit in vitamin B12 induced by N2O. The management of acute complications is symptomatic. The management of chronic complications is based on vitamin B12 supplementation. The best biomarker of chronic N2O exposure is the elevation of the plasmatic level of methylmalonic acid. In all cases of recreational misuses, addiction treatment is necessary to prevent complications or their worsening by providing information in order to stop consumption.Copyright © 2021 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.

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