Eugene R Jalbert, Amir Fahmi, Carol Li, Mana Goshtasbi and Mohammed Zaman
Nitrous oxide (N2O) toxicity is a well-known entity. It is capable of inactivating vitamin B12, producing a relative B12 deficiency. Vitamin B12 is needed for neurologic development and is necessary for the body to complete vital biologic functions. We look at a case of a 28 year old patient who abused N2O, then went on to develop neurologic symptoms of ataxia, numbness and subacute combined degeneration of the dorsal columns as seen on MRI. Her symptoms were consistent with vitamin B12 deficiency despite having normal vitamin B12 levels by conventional lab measurements. Her methylmalonic acid (MMA) levels however were elevated. After administering daily B12 injections for 2 weeks and complete abstinence from N2O, her neurologic deficits have nearly resolved.