A 26-year-old Dutch man got brain damage after using ‘hippy crack’ laughing gas.
The patient, who has not been named, went to A&E confused and in and out of consciousness, and had been vomiting for several days.
His family revealed he had been using two litres of the popular recreational laughing gas – nitrous oxide – every week for six months.
Doctors ran tests and found the chemicals in his blood were off balance as a result, causing potentially life-threatening problems.
It had led to toxic-metabolic encephalopathy, a condition where the brain’s function is impaired causing mood changes, seizures, and muscle weakness.
After being treated in intensive care, the young man was discharged but his confusion as well as visual hallucinations remained for three months.
Doctors warned laughing gas can be perceived as a harmless way as getting high. But growing evidence is showing its damaging effect on the brain and body.
A 26-year-old Dutch man got brain damage after using ‘hippy crack’ laughing gas.
People normally inhale nitrous oxide (NO), a colourless gas, through a balloon. It is illegal, it is easily available to youngsters.
Just one balloon can lead to a lack of oxygen to the brain – people have died this way.
Heavy regular use of NO can lead to a deficiency of vitamin B12 and to a form of anaemia, with vague symptoms of weakness, shortness of breath, and fatigue.
Doctors led by Marissa Ginette Danielle Vive, at Haaglanden Medisch Centrum, wrote this story in BMJ Case Reports.
They said the man had gone to hospital with sudden onset of confusion after days of vomiting.
Upon physical examination, he ‘appeared intoxicated and was vomiting repeatedly’.
In the following days, his mental state kept changing. Sometimes he was completely unresponsive, while other times he was aggressive and spat at staff.
After tests were ran, medics found the man had hyperammonaemia – when there is excess of ammonia in the blood. It is dangerous because it can lead to brain injury and death.
It explained why the man was suffering with life-threatening encephalopathy – disease or damage to the brain.
Encephalopathy is when electrolytes, hormones, or other chemicals in the body become off their normal balance.
Symptoms of encephalopathy – sometimes permanent – include seizures, trembling, difficulty speaking, concentrating or remembering things, mood swings and muscle weakness.
The patient had consanguineous parents – meaning they were related when they had their child. Therefore, it was initially suspected the hyperammonemia was due to an underlying disorder – but this was ruled out.
Eventually, doctors concluded the cause of the hyperammonemia was a vitamin B12 deficiency.
Earlier tests had in fact revealed the man had low vitamin B12 – triggered by the overuse of nitrogen oxide.
Laughing gas can cause headaches or dizziness when inhaled and, in extreme cases, even lead to fainting or suffocation (Pictured: People holding balloons on Brick Lane, London, in 2014 – before the drug was illegal)
NO affects vitamin B12 levels by interfering with chemical pathways in the body, the doctors said.
After B12 suppletion and therapy to reduce the amount of ammonia in the blood, the man stopped going in and out of consciousness.
‘He was transferred from the intensive care unit back to the medical psychiatric care unit,’ the doctors wrote.
‘Although his consciousness improved, he remained confused with visual hallucinations, an attention deficit and dysphoric mood.
‘These psychiatric sequelae diminished over the course of three months. Hereafter, the patient reported having no residual complaints.’
Dr Vive and colleagues revealed hyperammonaemia induced by vitamin B12 deficiency has not previously been reported in medical literature.
This, they said, may be because if a patient who uses NO has an altered mental state, it may be assumed it’s because other drugs or alcohol.