Global Burden Related to Nitrous Oxide Exposure in Medical and Recreational Settings: A Systematic Review and Individual Patient Data Meta-Analysis

Journal of Clinical Medicine

Charlotte Stephan¹  Marion Wandzel¹  Julien Levy¹  Pierre Filhine-Tresarrieu¹  Mélissa Julien¹  Elodie Laugel¹  Olivia Hajjar¹  Claire Franczak¹  Ralph Green²  Abderrahim Oussalah³  Jean-Louis Guéant³ 

[1] Department of Molecular Medicine and Personalized Therapeutics, Division of Biochemistry, Molecular Biology, Nutrition, and Metabolism, University Hospital of Nancy, F-54000 Nancy, France;Department of Pathology and Laboratory Medicine, University of California, Davis, Sacramento, CA 95817, USA;University of Lorraine, INSERM UMR_S 1256, Nutrition, Genetics, and Environmental Risk Exposure (NGERE), Faculty of Medicine of Nancy, F-54000 Nancy, France;

关键词: global health;    global burden related to nitrous oxide exposure;    medical and recreational settings;    individual patient data meta-analysis;    nitrous oxide-related toxicity;    vitamin B12 deficiency;    one-carbon metabolism;    homocysteine;    methylmalonic acid;   

DOI  :  10.3390/jcm8040551

来源: DOAJ

【 摘 要 】

The risk of adverse effects of nitrous oxide (N₂O) exposure is insufficiently recognized despite its widespread use. These effects are mainly reported through case reports. We conducted an individual patient data meta-analysis to assess the prevalence of clinical, laboratory, and magnetic resonance findings in association with N₂O exposure in medical and recreational settings. We calculated the pooled estimates for the studied outcomes and assessed the potential bias related to population stratification using principal component analysis. Eighty-five publications met the inclusion criteria and reported on 100 patients with a median age of 27 years and 57% of recreational users. The most frequent outcomes were subacute combined degeneration (28%), myelopathy (26%), and generalized demyelinating polyneuropathy (23%). A T2 signal hyperintensity in the spinal cord was reported in 68% (57.2–78.8%) of patients. The most frequent clinical manifestations included paresthesia (80%; 72.0–88.0%), unsteady gait (58%; 48.2–67.8%), and weakness (43%; 33.1–52.9%). At least one hematological abnormality was retrieved in 71.7% (59.9–83.4%) of patients. Most patients had vitamin B12 deficiency: vitamin B12 <150 pmol/L (70.7%; 60.7–80.8%), homocysteine >15 µmol/L (90.3%; 79.3–100%), and methylmalonic acid >0.4 µmol/L (93.8%; 80.4–100%). Consistently, 85% of patients exhibited a possibly or probably deficient vitamin B12 status according to the cB12 scoring system. N₂O can produce severe outcomes, with neurological or hematological disorders in almost all published cases. More than half of them are reported in the setting of recreational use. The N₂O-related burden is dominated by vitamin B12 deficiency. This highlights the need to evaluate whether correcting B12 deficiency would prevent N₂O-related toxicity, particularly in countries with a high prevalence of B12 deficiency.

【 授权许可】

Unknown