Right iliac deep vein thrombosis
and pulmonary embolism associated
with recreational nitrous oxide: a case report
Dublin Core
Title
Right iliac deep vein thrombosis
and pulmonary embolism associated
with recreational nitrous oxide: a case report
and pulmonary embolism associated
with recreational nitrous oxide: a case report
Subject
Thrombosis, Pulmonary embolism, Nitrous oxide abuse, Vitamin B12, Hyperhomocysteinaemia
Description
Abstract
Background The recreational use of nitrous oxide is becoming increasingly common among teenagers and young
adults. Since 2018, the use of nitrous oxide has increased exponentially and has become a public health problem.
Case presentation A 23-year-old patient was referred to accident and emergency (A&E) by his general practitioner
for deterioration in general condition, vomiting, diarrhea and febrile headache at 39 °C.
He reported that he had been partying for a month and consuming alcohol, cannabis and nitrous oxide. Three
days before the consultation, he reported increased abdominal pain in the right iliac fossa. His homocysteine con-
centration was 51.9 μmol/L, and his plasma methyl malonate concentration increased to 4.45 μmol/L. A thoracic
and abdominal CT scan revealed right iliac venous thrombosis associated with bilateral pulmonary embolism.
Conclusion Nitrous oxide inhibits the activity of methionine synthetase. We therefore observed an increase
in plasma homocysteine and 5-methyl-THF. The increase in homocysteine could be responsible for the pro-throm-
botic activity resulting from nitrous oxide intoxication. At present, no threshold or duration of exposure has been
identified as being particularly likely to cause complications. It is likely that other factors coexist, such as coagulation
disorders and polymorphisms of the MHTFR gene, which can lead to hyperhomocysteinaemia, cannabis consump-
tion, inflammatory conditions and others. Treatment is based on vitamin B12 supplementation and curative antico-
agulation. Some authors also recommend folate supplementation.
Consumption of nitrous oxide could be associated with arterial and venous thromboembolic disease.
Keywords Thrombosis, Pulmonary embolism, Nitrous oxide abuse, Vitamin B12, Hyperhomocysteinaemia
Background The recreational use of nitrous oxide is becoming increasingly common among teenagers and young
adults. Since 2018, the use of nitrous oxide has increased exponentially and has become a public health problem.
Case presentation A 23-year-old patient was referred to accident and emergency (A&E) by his general practitioner
for deterioration in general condition, vomiting, diarrhea and febrile headache at 39 °C.
He reported that he had been partying for a month and consuming alcohol, cannabis and nitrous oxide. Three
days before the consultation, he reported increased abdominal pain in the right iliac fossa. His homocysteine con-
centration was 51.9 μmol/L, and his plasma methyl malonate concentration increased to 4.45 μmol/L. A thoracic
and abdominal CT scan revealed right iliac venous thrombosis associated with bilateral pulmonary embolism.
Conclusion Nitrous oxide inhibits the activity of methionine synthetase. We therefore observed an increase
in plasma homocysteine and 5-methyl-THF. The increase in homocysteine could be responsible for the pro-throm-
botic activity resulting from nitrous oxide intoxication. At present, no threshold or duration of exposure has been
identified as being particularly likely to cause complications. It is likely that other factors coexist, such as coagulation
disorders and polymorphisms of the MHTFR gene, which can lead to hyperhomocysteinaemia, cannabis consump-
tion, inflammatory conditions and others. Treatment is based on vitamin B12 supplementation and curative antico-
agulation. Some authors also recommend folate supplementation.
Consumption of nitrous oxide could be associated with arterial and venous thromboembolic disease.
Keywords Thrombosis, Pulmonary embolism, Nitrous oxide abuse, Vitamin B12, Hyperhomocysteinaemia
Creator
Thomas Bizouard1*, Catherine Caplette1
, Damien Duval1
, Dominique Savary1,2 and Delphine Douillet1,2,3
, Damien Duval1
, Dominique Savary1,2 and Delphine Douillet1,2,3
Source
https://doi.org/10.1186/s12245-024-00689-z
Date
2024
Contributor
Peri Irawan
Format
pdf
Language
english
Type
text
Files
Collection
Citation
Thomas Bizouard1*, Catherine Caplette1
, Damien Duval1
, Dominique Savary1,2 and Delphine Douillet1,2,3, “Right iliac deep vein thrombosis
and pulmonary embolism associated
with recreational nitrous oxide: a case report,” Repository Horizon University Indonesia, accessed April 25, 2026, https://repository.horizon.ac.id/items/show/12408.
and pulmonary embolism associated
with recreational nitrous oxide: a case report,” Repository Horizon University Indonesia, accessed April 25, 2026, https://repository.horizon.ac.id/items/show/12408.