Re: Vitamin B12: Do not forger nitrous oxide abuse as a cause of deficiency in availability of Vitamin B12

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Dear Editor
In this day and age, no account of Vitamin B12 deficiency would be complete without mention of nitrous oxide abuse as a cause of poor bioavailability of Vitamin B12.
The toxicity of nitrous oxide is mediated by oxidation and, hence, inactivation of vitamin B12. The result is an impairment of conversion of homocysteine to methionine, the latter a necessary step in myelin production, both in the central and in the peripheral nervous system[1].
As a consequence, nitrous oxide-related myeloneuropathy simulates myeloneuropathy attributable to vitamin B12 deficiency, both by causing symptoms such as those typically associated with subacute combined degeneration of the spinal cord, and by causing symptoms attributable to peripheral neuropathy.
Nitrous oxide abuse can also cause symptoms simulating those attributable to Guillain-Barre syndrome[2].
The neurological symptoms of nitrous oxide abuse resolve after a regime consisting of vitamin B12 injections coupled with discontinuation(albeit sometimes transient) of nitrous oxide abuse.
I have no conflict of interest.
References
[1]Xiang Y., Ma X., Li S
Recreational nitrous oxide abuse: prevalence, neurotoxicity, and treatment
Neurotox Res 2021;39:975-978
[2] Jolobe OMP
Nitrous oxide myeloneuropathy as the differential diagnosis of Guillain Barre syndrome
American Journal of Emergency Medicne
Article in Press
doi.org/10.1016/j.ajem.2023.11.016

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Electronic Publication Date: 
Saturday, November 25, 2023 – 13:18
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Re: Vitamin B12: Do not forger nitrous oxide abuse as a cause of deficiency in availability of Vitamin B12

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Last Name: 
jolobe
First name and middle initial: 
oscar,m
Address: 
flat 6 souchay court
Occupation: 
retired geriatrician
Affiliation: 
British Medical Association
BMJ: Additional Article Info: 
Rapid response

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