Drug-induced psychosis and neurological effects following nitrous oxide misuse: A case report

Nitrous oxide (N2O) is an increasingly popular recreational drug globally. Users commonly inhale the gas from punctured canisters known as "whippits" that are designed for use in whipped cream dispensers. A surge in N2O use has been reported in the UK, with a self-report recreational drug survey finding an increase in use from 20% in 2014 to 31% in 2017.The survey found that when nicotine, alcohol, and caffeine were excluded, N2O was the seventh most common drug used by respondents. The accessibility of N2O as a consumer good contributes to misuse, as seen in the case of a 20-year-old female who presented to the emergency department complaining of visual and auditory hallucinations.The patient had no history of psychiatric or medical illness before experiencing symptoms, and results from laboratory investigations and physical examinations revealed no abnormalities. The patient reported inhaling nitrous oxide on a daily basis, however, and had recently increased her use of legally obtained whippits. A psychiatrist, a neurologist, and an addictions medicine specialist assessed the patient in consultation and agreed that her psychosis was the result of N2O misuse. This case illustrates the need to increase awareness regarding the possible sequalae of nitrous oxide misuse and address current reporting limitations and the ease of access consumers have to nitrous oxide products.