Fatal pulmonary thromboembolism associated with excessive nitrous oxide consumption over several weeks.
Stefanie Plenzig, Friederike Pijahn, Alexander Müller et al.
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Case in brief
A man in his early twenties was hospitalized with acute nitrous oxide intoxication, vitamin B12 deficiency and anaemia. Two weeks later, he was found dead; empty nitrous oxide cartridges were present, and his mother reported excessive use for approximately two months. Autopsy showed fatal pulmonary embolism secondary to deep vein thrombosis, while toxicology detected low concentrations of nitrous oxide in blood. The authors considered suspected hyperhomocysteinemia related to B12 deficiency a possible contributor to thrombosis, alongside obesity and nicotine use. Toxicology supported recent exposure but could not establish the underlying biochemical disturbance.
What made this case unusual
The proposed link between repeated nitrous oxide use, functional B12 deficiency and a potentially prothrombotic biochemical disturbance offers a possible explanation for fatal pulmonary embolism in a young man; the authors present this as contributory, not proven.
Diagnostic / clinical pearl
In a young person with fatal thromboembolism and a history of repeated nitrous oxide use, consider functional B12 deficiency and associated biochemical derangements. A positive toxicology result may support recent exposure but cannot establish the underlying pathology.